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Changes in the Risk for Major Depression Seen in Landmark Study

The largest study ever done on major depressive disorder and co-occurring disorders provides the most definitive information, to date, of major depressive disorder (MDD) in specific population subgroups, and of the relationship of MDD to alcohol use disorders, drug disorders and other mental health conditions. Published in the October issue of the Archives of General Psychiatry, the study highlights new information on the risk patterns for MDD among adults, indicating greater risk for people ranging in age from 45 to 64 years. The study also indicates differences in the relationship of MDD to specific substances of abuse, anxiety and personality disorders, and paints a clearer picture of the rate of MDD among different ethnic groups.

Dr. Deborah Hasin, Professor of Clinical Public Health in the Departments of Epidemiology and Psychiatry at Columbia University and Research Scientist at New York State Psychiatric Institute, led the research. The study used data from the 2001-2002 National Epidemiologic Survey of Alcohol and Related Conditions (NESARC). The NESARC survey involved face-to-face interviews with more than 43,000 non-institutionalized individuals aged 18 years and older. The analysis indicates that 5.28 percent of U.S. adults experienced MDD during the 12 months preceding the survey and 13.23 percent experienced MDD at any time during their lives. A notable new finding was that the highest lifetime risk was found among middle-aged adults, an important shift from surveys conducted during the 1980s and 1990s that showed greatest risk among the youngest adults.

Among respondents with current MDD, 14.1 percent also have an alcohol use disorder, 4.6 percent have a drug use disorder, and 26 percent have nicotine dependence. Among persons with lifetime MDD, 40.3 percent experienced an alcohol use disorder, 17.2 percent experienced a drug use disorder, and 30 percent experienced nicotine dependence.

“The NESARC survey, along with those of earlier epidemiological studies, also demonstrate a strong relationship of MDD to substance dependence and a weak relationship to substance abuse. This finding indicates the importance of focusing on dependence when studying the relationship of depression to substance use disorders,” said Dr. Hasin.

The study was the first national psychiatric epidemiology survey that included a large enough sample of Native Americans to compare their risk to other groups. Native Americans were found to be at significantly higher risk for major depression than other racial/ethnic groups.

“This study provides the grounds for further investigation in a number of important areas,” the authors noted, including reasons for the change in the age distribution and factors that explain the higher rates in Native Americans.

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