Elsevier

Clinical Psychology Review

Volume 31, Issue 7, November 2011, Pages 1117-1125
Clinical Psychology Review

Prevalence and clinical course of depression: A review

https://doi.org/10.1016/j.cpr.2011.07.004Get rights and content

Abstract

Depression is one of the leading causes of disease worldwide. Historically conceived as either a disease of the mind or of the brain, treatment options followed this aetiology. Current diagnostic assessment of depression is based on descriptions of symptoms, their presence and magnitude over time. Epidemiological studies demonstrate that depressive disorders are highly prevalent: displaying high rates of lifetime incidence, early age onset, high chronicity, and role impairment. These studies have deepened our understanding of the course of depression; remission, recovery, relapse and recurrence. An illustration of recovery rates has begun to demonstrate the complexity of the nature and course of depression. The majority recovers; however, recovery may not be permanent and future episodes carry the threat of chronicity. A key variable influencing rates of recovery, relapse, and recurrence is the presence of medical or psychiatric comorbid illnesses. The review considers the literature on Major Depression beginning with a brief historical overview, its classification, and a synthesis of the current knowledge regarding prevalence and course.

Highlights

► Epidemiological studies demonstrate that depressive disorders are highly prevalent. ► Recovery rates have begun to demonstrate the complexity of the nature and course of depression. ► Relapse and recurrence are key in understanding depression, as they carry the threat of chronicity. ► A key variable influencing recovery is the presence of comorbid illnesses, medical or psychiatric. ► The global cost of depression far outweighs the cost to treating successfully those who suffer.

Introduction

Depression is one of the most commonly diagnosed mental disorders among adults. Our understanding of the course and nature of depression has changed significantly in the last 20 years. From being seen as an acute and self-limiting illness, to a growing clarity that for many depression is now considered a chronic, lifelong illness. Prevalence of depression is of concern, as the cost that depression exacts is considerable. It is not only economically detrimental, but also engenders significant personal and interpersonal suffering alongside its societal impact (Johnson, Weissman, & Klerman, 1992). This review considers the literature on Major Depression beginning with a brief historical overview, its classification, and a synthesis of the current knowledge regarding prevalence and course.

Section snippets

Historical development

Historically, mood disorders have been conceived as either “organic” or “reactive,” as found in the Diagnostic and Statistical Manual of Mental Disorders—First Edition (DSM-I) (American Psychiatric Association [APA], 1952). The second edition of the manual (DSM-II) (American Psychiatric Association [APA], 1968) continues this basic distinction using the terms “psychotic” and “neurotic.” Mood disorders were understood as either a disease of the brain and organic, or neurotic and therefore a

Classification

The Diagnostic and Statistical Manual of Mental Disorders—Fourth Edition (DSM-IV-TR) (American Psychiatric Association [APA], 2000) describes a Major Depressive Disorder (MDD) diagnosis based on the presence of a specified number of symptoms with a precise duration. Primarily symptoms of either depressed mood or loss of interest or pleasure are present. Additionally the criteria of at least five items from the DSM-IV-TR (APA, 2000) list need to be present for a duration of 2 weeks and as such,

Epidemiology of depression

Several major epidemiological studies have been carried out to determine the prevalence of depressive disorder in the general population. Two such large scale surveys from the U.S. are the Baltimore Epidemiologic Catchment Area Survey (ECA) (Eaton et al., 1989) and the National Comorbidity Survey (NCS), initially conducted in 1991 and replicated in 2001 (Kessler et al., 1994, Kessler et al., 2003). Using the Diagnostic Interview Schedule (DIS) (Robins, Helzer, Croughan, & Ratcliff, 1981) based

The cost of depression

Overall the picture painted is similar across the surveys of prevalence throughout the world. Data clearly identify depression as a major public health problem (Scott & Dickey, 2003). Depression exacts a huge cost on the individual and their personal circumstances. It contributes to enormous loss for society as well.

A recent economic review of the cost of depression reports that the direct cost of depression is accounted for by high healthcare usage, the majority of which is not the result of

The course of depression: Remission, recovery, relapse and recurrence

Early empirical studies investigating the course of depression were hindered by a lack of consensus about key points of change that were being observed in the results. This was resolved and the key change points were named and defined by a task force, see Table 1 (Frank et al., 1991).

What follows is a discussion of the research reports on the course of depression. Three large scale studies to note are firstly, the National Institute of Mental Health (NIMH) Collaborative Depression Study (CDS) (

Conclusion

The growing prevalence of depression worldwide is of concern, especially given the associated economic, societal, personal, and interpersonal costs. The global cost of depression far outweighs the cost to understanding it accurately and treating successfully those who suffer. Because depression displays high rates of lifetime prevalence, early age of onset, high chronicity, and role impairment, the WHO has ranked depression as the single most burdensome disease in the world in terms of years

Acknowledgments

Thanks to Thomas Richardson for reading an earlier draft and providing helpful comments. Thanks to Candice Aguilar for proofreading the document.

References (96)

  • American Psychiatric Association [APA]

    Diagnostic and statistical manual of mental disorders (DSM-II)

    (1968)
  • American Psychiatric Association [APA]

    Diagnostic and statistical manual of mental disorders (DSM-III)

    (1980)
  • American Psychiatric Association [APA]

    Diagnostic and statistical manual of mental disorders (DSM-III-R)

    (1987)
  • American Psychiatric Association [APA]

    Diagnostic and statistical manual of mental disorders (DSM-IV)

    (1994)
  • American Psychiatric Association [APA]

    Diagnostic and statistical manual of mental disorders (DSM-IV-TR)

    (2000)
  • G. Andrews et al.

    Classification in psychiatry: ICD-10 versus DSM-IV

    British Journal of Psychiatry

    (1999)
  • J. Angst

    The course of major depression, atypical bipolar disorder, and bipolar disorder

  • J. Angst

    How recurrent and predictable is depressive illness?

  • J. Angst et al.

    Course of monopolar depression and bipolar psychoses

    Psychiatria Neurologia Neurochirurgia

    (1973)
  • M. Ansseau et al.

    Socioeconomic correlates of generalized anxiety disorder and major depression in primary care: The GADIS II study (Generalized Anxiety and Depression Impact Survey II)

    Depression and Anxiety

    (2008)
  • J.L. Ayuso-Mateos et al.

    Depressive disorders in Europe: Prevalence figures from the ODIN study

    British Journal of Psychiatry

    (2001)
  • P.E. Bebbington et al.

    The influence of age and sex on the prevalence of depressive conditions: Report from the National Survey of Psychiatric Morbidity

    Psychological Medicine

    (1998)
  • A.T. Beck et al.

    An inventory for measuring depression

    Archives of General Psychiatry

    (1961)
  • R.J. Boland et al.

    Course and outcome of depression

  • K.H. Bourdon et al.

    Estimating the prevalence of mental disorders in U.S. adults from the Epidemiologic Catchment Area Survey

    Public Health Reports

    (1992)
  • T.A. Brown et al.

    Current and lifetime comorbidity of the DSM-IV anxiety and mood disorders in a large clinical sample

    Journal of Abnormal Psychology

    (2001)
  • K.C. Burke et al.

    Comparing age at onset of major depression and other psychiatric disorders by birth cohorts in five US community populations

    Archives of General Psychiatry

    (1991)
  • D. Chrisholm et al.

    Depression status, medical comorbidity and resource costs: Evidence from an international study of major depression in primary care (LIDO)

    British Journal of Psychiatry

    (2003)
  • CoinNews Media Group LLC

    US inflation calculator

  • J.R. Copeland et al.

    Depression among older people in Europe: The EURODEP studies

    World Psychiatry

    (2004)
  • W. Coryell et al.

    Outcome of patients with chronic affective disorder: A five-year follow- up

    American Journal of Psychiatry

    (1990)
  • W.E. Craighead et al.

    Psychosocial treatments for major depressive disorder

  • J.M. Donohue et al.

    Reducing the societal burden of depression: A review of economic costs, quality of care and effects of treatment

    PharmacoEconomics

    (2007)
  • B.G. Druss et al.

    Health and disability costs of depressive illness in a major U.S. corporation

    American Journal of Psychiatry

    (2000)
  • W.W. Eaton et al.

    Natural history of Diagnostic Interview Schedule/DSM-IV major depression: The Baltimore Epidemiologic Catchment Area follow-up

    Archives of General Psychiatry

    (1997)
  • W.W. Eaton et al.

    The incidence of specific DIS/DSM-III Mental Disorders: Data from the NIMH Epidemiologic Catchment Area Program

    Acta Psychiatrica Scandinavica

    (1989)
  • W.W. Eaton et al.

    Population-based study of first onset and chronicity in major depressive disorder

    Archives of General Psychiatry

    (2008)
  • C. Faravelli et al.

    Depressive relapses and incomplete recovery from index episode

    American Journal of Psychiatry

    (1986)
  • E. Frank et al.

    Conceptualization and rationale for consensus definitions of terms in major depressive disorder: Remission, recovery, relapse, and recurrence

    Archives of General Psychiatry

    (1991)
  • S. Gilbody et al.

    Costs and consequences of enhanced primary care for depression: Systematic review of randomised economic evaluations

    British Journal of Psychiatry

    (2006)
  • P.E. Greenberg et al.

    The economic burden of depression in the United States: How did it change between 1990 and 2000?

    Journal of Clinical Psychiatry

    (2003)
  • K.M. Holma et al.

    Incidence and predictors of suicide attempts in DSM-IV major depressive disorder: A five-year prospective study

    American Journal of Psychiatry

    (2010)
  • J. Johnson et al.

    Service utilization and social morbidity associated with depressive symptoms in the community

    JAMA

    (1992)
  • L.L. Judd et al.

    A prospective 12-year study of subsyndromal and syndromal depressive symptoms in unipolar major depressive disorders

    Archives of General Psychiatry

    (1998)
  • L.L. Judd et al.

    Does incomplete recovery from first lifetime major depressive episode herald a chronic course of illness?

    American Journal of Psychiatry

    (2000)
  • T. Kanai et al.

    Time to recurrence after recovery from major depressive episodes and its predictors

    Psychological Medicine

    (2003)
  • M.M. Katz et al.

    NIMH Clinical Research Branch Collaborative Program on the psychobiology of depression

    Archives of General Psychiatry

    (1979)
  • Cited by (433)

    View all citing articles on Scopus
    1

    Derek Richards is currently on career break.

    View full text