Epidemiology of Adult DSM-5 Major Depressive Disorder and Its Specifiers in the United States

Abstract

<div class="section"> <a class="named-anchor" id="ab-yoi170112-1"> <!-- named anchor --> </a> <h5 class="section-title" id="d1550506e347">Question</h5> <p id="d1550506e349">What is the national prevalence of <i>DSM-5</i> major depressive disorder, the <i>DSM-5</i> anxious/distressed and mixed-features specifiers, and their clinical correlates? </p> </div><div class="section"> <a class="named-anchor" id="ab-yoi170112-2"> <!-- named anchor --> </a> <h5 class="section-title" id="d1550506e358">Findings</h5> <p id="d1550506e360">In this national survey of 36 309 US adults, the 12-month and lifetime prevalences of major depressive disorder were 10.4% and 20.6%, respectively, with most being moderate (6-7 symptoms) or severe (8-9 symptoms) and associated with comorbidity and impairment. The anxious/distressed specifier characterized 74.6% of major depressive disorder cases, and the mixed-features specifier characterized 15.5%; almost 70% with lifetime major depressive disorder received some type of treatment. </p> </div><div class="section"> <a class="named-anchor" id="ab-yoi170112-3"> <!-- named anchor --> </a> <h5 class="section-title" id="d1550506e363">Meaning</h5> <p id="d1550506e365">Major depressive disorder remains a serious US health problem, with much to be learned about its specifiers. </p> </div><div class="section"> <a class="named-anchor" id="ab-yoi170112-4"> <!-- named anchor --> </a> <h5 class="section-title" id="d1550506e369">Importance</h5> <p id="d1550506e371">No US national data are available on the prevalence and correlates of <i>DSM-5</i>–defined major depressive disorder (MDD) or on MDD specifiers as defined in <i>DSM-5</i>. </p> </div><div class="section"> <a class="named-anchor" id="ab-yoi170112-5"> <!-- named anchor --> </a> <h5 class="section-title" id="d1550506e380">Objective</h5> <p id="d1550506e382">To present current nationally representative findings on the prevalence, correlates, psychiatric comorbidity, functioning, and treatment of <i>DSM-5</i> MDD and initial information on the prevalence, severity, and treatment of <i>DSM-5</i> MDD severity, anxious/distressed specifier, and mixed-features specifier, as well as cases that would have been characterized as bereavement in <i>DSM-IV</i>. </p> </div><div class="section"> <a class="named-anchor" id="ab-yoi170112-6"> <!-- named anchor --> </a> <h5 class="section-title" id="d1550506e394">Design, Setting, and Participants</h5> <p id="d1550506e396">In-person interviews with a representative sample of US noninstitutionalized civilian adults (≥18 years) (n = 36 309) who participated in the 2012-2013 National Epidemiologic Survey on Alcohol and Related Conditions III (NESARC-III). Data were collected from April 2012 to June 2013 and were analyzed in 2016-2017. </p> </div><div class="section"> <a class="named-anchor" id="ab-yoi170112-7"> <!-- named anchor --> </a> <h5 class="section-title" id="d1550506e399">Main Outcomes and Measures</h5> <p id="d1550506e401">Prevalence of <i>DSM-5</i> MDD and the <i>DSM-5</i> specifiers. Odds ratios (ORs), adjusted ORs (aORs), and 95% CIs indicated associations with demographic characteristics and other psychiatric disorders. </p> </div><div class="section"> <a class="named-anchor" id="ab-yoi170112-8"> <!-- named anchor --> </a> <h5 class="section-title" id="d1550506e410">Results</h5> <p id="d1550506e412">Of the 36 309 adult participants in NESARC-III, 12-month and lifetime prevalences of MDD were 10.4% and 20.6%, respectively. Odds of 12-month MDD were significantly lower in men (OR, 0.5; 95% CI, 0.46-0.55) and in African American (OR, 0.6; 95% CI, 0.54-0.68), Asian/Pacific Islander (OR, 0.6; 95% CI, 0.45-0.67), and Hispanic (OR, 0.7; 95% CI, 0.62-0.78) adults than in white adults and were higher in younger adults (age range, 18-29 years; OR, 3.0; 95% CI, 2.48-3.55) and those with low incomes ($19 999 or less; OR, 1.7; 95% CI, 1.49-2.04). Associations of MDD with psychiatric disorders ranged from an aOR of 2.1 (95% CI, 1.84-2.35) for specific phobia to an aOR of 5.7 (95% CI, 4.98-6.50) for generalized anxiety disorder. Associations of MDD with substance use disorders ranged from an aOR of 1.8 (95% CI, 1.63-2.01) for alcohol to an aOR of 3.0 (95% CI, 2.57-3.55) for any drug. Most lifetime MDD cases were moderate (39.7%) or severe (49.5%). Almost 70% with lifetime MDD had some type of treatment. Functioning among those with severe MDD was approximately 1 SD below the national mean. Among 12.9% of those with lifetime MDD, all episodes occurred just after the death of someone close and lasted less than 2 months. The anxious/distressed specifier characterized 74.6% of MDD cases, and the mixed-features specifier characterized 15.5%. Controlling for severity, both specifiers were associated with early onset, poor course and functioning, and suicidality. </p> </div><div class="section"> <a class="named-anchor" id="ab-yoi170112-9"> <!-- named anchor --> </a> <h5 class="section-title" id="d1550506e415">Conclusions and Relevance</h5> <p id="d1550506e417">Among US adults, <i>DSM-5</i> MDD is highly prevalent, comorbid, and disabling. While most cases received some treatment, a substantial minority did not. Much remains to be learned about the <i>DSM-5</i> MDD specifiers in the general population. </p> </div><p class="first" id="d1550506e426">This national survey of US adults presents findings on the prevalence, correlates, psychiatric comorbidity, functioning, and treatment of <i>DSM-5</i> major depressive disorder. </p>