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– WHO is leading a one-year global campaign on depression. The highlight is World Health Day , celebrated today. The goal of the campaign.
Table of contents

Methodological studies reviewed here find no evidence that the substantial cross-national variation in prevalence estimates reviewed here, with the highest prevalence estimates found in some of the wealthiest countries in the world, is due as methodological factors, adding indirect support to a substantive interpretation of observed cross-national differences in MDE prevalence estimates.

Why these differences exist is less clear, as on one level it seems counter-intuitive that people in high income countries would experience more stress than those in low-middle income countries. However, it has been suggested that depression is to some extent an illness of affluence A related argument is that income inequality, which is for the most part greater in high than low-middle income countries, promotes a wide variety of chronic conditions that includes depression It is hoped that future epidemiological research sheds light on these perspectives.

In considering a substantive interpretation of the international data on prevalence of major depression, it is noteworthy that while lifetime prevalence estimates were higher in high than low-middle income countries overall, no significant difference was found in month prevalence, which means that the ratio of month to lifetime prevalence estimates was higher in low-middle than high income countries.

It might be that these results reflect genuinely lower lifetime prevalence but higher persistence of depression in low-middle than high income countries, but another plausible and more parsimonious explanation is that error in recall of prior lifetime episodes in epidemiological surveys carried out in higher in low-middle than high income countries. Longitudinal data collection would be required to document such a difference rigorously 97 , Although such data do not currently exist, it is important to recognize this possibility of cross-national variation in recall error before launching an extensive investigation of substantive explanations.

Another implication of the methodological limitation of existing cross-national epidemiological surveys of major depression is that the cross-sectional nature of these surveys makes it impossible to determine the temporal direction of associations between depression and socio-demographic variables. This means that even though variables such as education and marital status are typically considered predictors of depression, they might actually be consequences or involved in reciprocal causal relationships with depression.

A final noteworthy limitation of existing epidemiological studies is that the assessments of major depression were almost certainly suboptimal, although interview translation, back-translation, and harmonization procedures have improved in recent cross-national surveys 43 and that blinded clinical reappraisal interviews in a number of recent surveys document good concordance between survey diagnoses of major depression and independent clinical diagnoses Despite these limitations, existing epidemiological data show clearly that major depression is a commonly occurring and seriously impairing disorder.

The high prevalence and persistence of major depression in the many different countries where epidemiological surveys have been administered confirm the worldwide importance of this disorder. Although evidence is not definitive that major depression plays a causal role in its associations with the many adverse outcomes reviewed here, the indirect evidence is sufficiently strong to argue for the likely cost-effectiveness of expanded depression treatment from a societal perspective Two separate large-scale randomized workplace depression treatment effectiveness trials have been carried out in the US to evaluate the cost-effectiveness of expanded treatment from an employer perspective , Both trials had positive returns-on-investment to employers.

A substantial expansion of worksite depression care management programs has occurred in the US subsequent to the publication of these trials Yet the proportion of people with depression who receive treatment remains low in much of the world. A recent US study found that only about half of workers with MDD received treatment in the year of interview and that fewer than half of treated workers received treatment consistent with published treatment guidelines Although the treatment rate was higher for more severe cases, even those with severe MDD often failed to receive treatment The WMH surveys show that treatment rates are even lower in many other developed countries and consistently much lower in developing countries Less information is available on rates of depression treatment among patients with chronic physical disorders, but available evidence suggests that expanded treatment could be of considerable value Randomized controlled trials are needed to increase our understanding of the effects of detection and treatment of major depression among people in treatment for chronic physical disorders.

In addition, controlled effectiveness trials with long-term follow-ups are needed to increase our understanding of the effects of early detection and treatment on changes in life course role trajectories, role performance, and onset of secondary disorders. We thank the WMH staff for assistance with instrumentation, fieldwork, and data analysis. A complete list of WMH publications can be found at http: The funding organizations had no role in the study design; in the collection, analysis, and interpretation of data; in the writing of the manuscript; and in the decision to submit the manuscript for publication.

The costs of depression. Both used with permission. Kessler has had research support for his epidemiological studies from Analysis Group Inc. Bromet reports no competing interests. National Center for Biotechnology Information , U. Annu Rev Public Health. Author manuscript; available in PMC Jul Kessler 1 and Evelyn J. Author information Copyright and License information Disclaimer. The publisher's final edited version of this article is available at Annu Rev Public Health.

See other articles in PMC that cite the published article. Abstract Epidemiological data are reviewed on the prevalence, course, socio-demographic correlates, and societal costs of major depression throughout the world. Burden of illness, depression, epidemiology. Open in a separate window.

Depression is the no. 1 cause of ill health and disability worldwide | World Economic Forum

ILLNESS COURSE Few large-scale longitudinal general population studies of major depression exist, but clinical studies show that a substantial proportion of people who seek treatment for major depression have a chronic-recurrent course of illness 42 , Education Several studies show early-onset mental disorders associated termination of education 13 , 15 , 54 , 68 , 79 , , , Marital timing and stability Several studies have examined associations of pre-marital mental disorders with subsequent marriage 14 , 36 , Teen childbearing We are aware of only one study that examined the association between child-adolescent mental disorder and subsequent teen child bearing Employment status Although depression is known to be associated with unemployment, most research on this association has emphasized the impact of job loss on depression rather than depression as a risk factor for job loss Role performance A great deal of research has been carried out on the associations of mental disorders with various aspects of role performance, with a special focus on marital quality, work performance, and financial success.

Marital functioning It has long been known that marital dissatisfaction and discord are strongly related to depressive symptoms e. Parental functioning A number of studies have documented significant associations of both maternal 74 and paternal depression with negative parenting behaviors. Days out of role Considerable research has examined days out of role associated with various physical and mental disorders in an effort to produce data on comparative disease burden for health policy planning purposes 2 , Financial success One of most striking aspects of the impairment associated with MDD is that the personal earnings and household income of people with MDD are substantially lower than those of people without depression 35 , 45 , 56 , 72 , 78 , Comparative impairments A number of community surveys, most of them carried out in the US, have examined the comparative effects of diverse diseases on various aspects of role functioning 55 , 70 , 82 , , , Morbidity and mortality It is now well established that MDD is significantly associated with a wide variety of chronic physical disorders, including arthritis, asthma, cancer, cardiovascular disease, diabetes, hypertension, chronic respiratory disorders, and a variety of chronic pain conditions 6 , 18 , 22 , 31 , 32 , 81 , 92 , 96 , Major depression is a commonly occurring disorder in all countries where epidemiological surveys have been carried out.

What is depression?

However, lifetime prevalence estimates of major depression vary widely across countries, with prevalence generally higher in high income versus low-middle income countries. Age-of-onset AOO distributions show consistent evidence for a wide age range of risk with median AOO typically in early adulthood. Women consistently across countries have lifetime risk of major depression roughly twice that of men. Major depression is associated with a wide range of indicators of impairment and secondary morbidity, although some of these individual-level associations are stronger in high income than low-middle income countries.

Mental health correlates of intimate partner violence in marital relationships in a nationally representative sample of males and females. Disability and quality of life impact of mental disorders in Europe: Health-related quality of life associated with chronic conditions in eight countries: Days out of role due to common physical and mental conditions: Including information about co-morbidity in estimates of disease burden: The prevalence of comorbid depression in adults with diabetes: The epidemiology of major depressive episodes: Depression as a risk factor for mortality in patients with coronary heart disease: Psychological and pharmacological interventions for depression in patients with coronary artery disease.

Cochrane database of systematic reviews. Employer burden of mild, moderate, and severe major depressive disorder: Affective disorders and suicide risk: Depression, hopelessness, and desire for hastened death in terminally ill patients with cancer. Mental disorders and subsequent educational attainment in a US national sample. A multinational study of mental disorders, marriage, and divorce.

Childhood and adolescent onset psychiatric disorders, substance use, and failure to graduate high school on time. Key study of major depression prevalence in the WMH surveys. Epidemiology of psychiatric and alcohol disorders in Ukraine: Comorbidity of physical and mental disorders and the effect on work-loss days.

Butterworth P, Rodgers B. Mental health problems and marital disruption: Symptoms of depression as a risk factor for incident diabetes: Depression as a risk factor for cardiac mortality and morbidity: The vital link between chronic disease and depressive disorders. Major depressive disorder is a risk factor for low bone mass, central obesity, and other medical conditions. Cluley S, Cochrane GM. Psychological disorder in asthma is associated with poor control and poor adherence to inhaled steroids. Cohen S, Rodriquez MS. Pathways linking affective disturbances and physical disorders.

The assessment of chronic health conditions on work performance, absence, and total economic impact for employers. Marital quality, coping with conflict, marital complaints, and affection in couples with a depressed wife. Cuijpers P, Schoevers RA. Increased mortality in depressive disorders: Marriage and depressive symptoms: Major depression and comorbid substance use disorders.

The prevalence of psychiatric disorders among cancer patients. Psychiatric disorder in the context of physical illness. Adversity, Stress and Psychopathology. Oxford University Press; Common mental disorders, unemployment and welfare benefits in England. The effects of psychiatric disorders on the probability and timing of first marriage. Depressive symptoms and history of depression predict rehabilitation efficiency in stroke patients. The long shadow cast by childhood physical and mental problems on adult life. The economic burden of depression in the United States: Depression and cancer risk: Depressive symptoms and mortality in men: Prevalence and predictors of recurrence of major depressive disorder in the adult population.

Global perspectives on the epidemiology of mental disorders. Cambridge University Press; Assessing the economic costs of serious mental illness. The health consequences of economic recessions.

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Katon W, Ciechanowski P. Impact of major depression on chronic medical illness.

Symptoms of depression

The association of depression and anxiety with medical symptom burden in patients with chronic medical illness. Early-life mental disorders and adult household income in the World Mental Health Surveys. Prevalence and effects of mood disorders on work performance in a nationally representative sample of U. Age of onset of mental disorders: Social consequences of psychiatric disorders, II: Social consequences of psychiatric disorders, I: The effects of chronic medical conditions on work loss and work cutback.

Individual and societal effects of mental disorders on earnings in the United States: The prevalence and correlates of workplace depression in the national comorbidity survey replication. Patterns and mental health predictors of domestic violence in the United States: Largest and most recent cross-national epidemiological study of correlates of major depression. Global Perspectives on the Epidemiology of Mental Disorders.

The social consequences of psychiatric disorders, III: Depression and immune function: Men's aggression toward women: The era of affluence and its discontents. Quality of marital relationship and depression: Mental disorders and termination of education in high-income and low- and middle-income countries: Depressive symptomatology as a predictor of exposure to intimate partner violence among US female adolescents and young adults.

Work disability resulting from chronic health conditions. Five-year risk of cardiac mortality in relation to initial severity and one-year changes in depression symptoms after myocardial infarction.

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Associations of serious mental illness with earnings: Predictors of the persistence of male aggression in early marriage. Maternal depression and parenting behavior: Maternal depression and the quality of marital relationship: Womens Health Larchmt ; Self-efficacy, depressive symptoms, and patients' expectations predict outcomes in asthma.

Measuring the health burden of chronic disease and injury using health adjusted life expectancy and the Health Utilities Index. Estimating the employment and earnings costs of mental illness: Childhood emotional and behavioral problems and educational attainment. The association between income and distress, mental disorders, and suicidal ideation and attempts: Mood and anxiety disorders associated with chronic pain: The impact of comorbidity of mental and physical conditions on role disability in the US adult household population. Premarital mental disorders and physical violence in marriage: How common are common mental disorders?

Evidence that lifetime prevalence rates are doubled by prospective versus retrospective ascertainment. Suicide, suicidality and suicide prevention in affective disorders. Depression, chronic diseases, and decrements in health: The role of depression and chronic pain conditions in absenteeism: Socioeconomic position and major mental disorders. Evidence-based health policy--lessons from the Global Burden of Disease Study. The Global Burden of Disease: Harvard University Press; Most comprehensive study of comparative disease burdens ever undertaken.

Major depression estimated to be among the most burdensome disorders worldwide. Depression and cardiac disease. Descriptive epidemiology of intimate partner aggression in Ukraine. Prospective study of depressive symptoms and risk of stroke among japanese. Disability and treatment of specific mental and physical disorders across the world. Co-occurrence of mental and physical illness in US Latinos. Accumulation of major depressive episodes over time in a prospective study indicates that retrospectively assessed lifetime prevalence estimates are too low.

Recall of recent and more remote depressive episodes in a prospective cohort study. The psychosocial context of depressive rumination: Peyrot M, Rubin RR.

Depression is the no. 1 cause of ill health and disability worldwide

Levels and risks of depression and anxiety symptomatology among diabetic adults. Childhood trauma and psychiatric disorders as correlates of school dropout in a national sample of young adults. Depression, psychotropic medication, and risk of myocardial infarction. Prospective data from the Baltimore ECA follow-up. Marital quality and personal well-being: Intimate partner violence victimization and parenting stress: Risk for domestic violence: Suicide risk in mood disorders.

Mon 4 Jun Symptoms include eating or sleeping too much or too little; pulling away from people and usual activities; having low or no energy; feeling numb or like nothing matters; feeling unusually confused, forgetful, on edge, angry, upset, worried or scared; and thinking of harming yourself or others. A visceral description is quoted by the UK campaign group Mind: Eventually, I just feel numb and empty.

Depression is also often mixed with other health problems: The term dysthymia is also used for mild, long-term depression — usually lasting two years or more. Clinical depression has surged to epidemic proportions in recent decades, from little-mentioned misery at the margins of society to a phenomenon that is rarely far from the news. It is widespread in classrooms and boardrooms, refugee camps and inner cities, farms and suburbs.

Women are more likely to be depressed than men. Depression is the leading global disability, and unipolar as opposed to bipolar depression is the 10th leading cause of early death, it calculates.

The link between suicide, the second leading cause of death for young people aged , and depression is clear, and around the world two people kill themselves every minute. At the other end of the scale are Japan, Nigeria and China. Recent research points to myriad reasons, many overlapping: Also, people in these countries are more likely to feel a social stigma against talking about how they feel, and are reluctant to ask for professional help. A paper in the journal Plos Medicine argues that, extremes aside, the majority of countries have similar rates of depression.

It also found that the most depressed regions are eastern Europe, and north Africa and the Middle East; and that, by country, the highest rate of years lost to disability for depression is in Afghanistan, and the lowest in Japan.


Things have improved since people with mental illness were believed to be possessed by the devil and cast out of their communities, or hanged as witches. The Curse of the Strong. He argues there is a part of the brain called the limbic system that acts like a thermostat, controlling various functions of the body — including mood — and restoring equilibrium after the normal ups and downs of life. The limbic system is a circuit of nerves, transmitting signals to each other via two chemicals, serotonin and noradrenalin, of which people with depression have a deficit.

According to this description, depressive illness is predominantly a physical, not mental, illness. Cantopher says that, when under stress, weak or lazy people give in quickly; strong people keep going, redouble their efforts, fight any pressure to give up and so push the limbic system to breaking point. However, there is no scientific evidence to support this theory, as it is impossible to experiment on live brains.

Other commonly agreed causes or triggers are past trauma or abuse; a genetic predisposition to depression, which may or may not be the same as a family history; life stresses, including financial problems or bereavement; chronic pain or illness; and taking drugs, including cannabis, ecstasy and heroin.

The subject of much debate, there is a school of thought that severe stress or certain illnesses can trigger an excessive response from the immune system, causing inflammation in the brain, which in turn causes depression. The WHO estimates that fewer than half of people with depression are receiving treatment.