Major Depression Found Prevalent, Costly

Study: 1 in 6 have severe bout, usually with another problem

(HealthDay is the new name for HealthScoutNews.)

TUESDAY, June 17, 2003 (HealthDayNews) -- One in six American adults, or more than 32 million people, will suffer a bout of major depression in their lifetime, yet only about a fifth will receive appropriate care for their illness.

A new study, based on in-person surveys of more than 9,000 men and women, found that 16 percent reported at least one episode of depression deep enough to seriously shake their work, family or social life. It appears in the June 18 issue of the Journal of the American Medical Association.

It also finds that depression usually doesn't act alone. The vast majority of those in this study had an accompanying mental ailment.

More than 6 percent said they'd had such an event in the last year, and half of these were severe or very severe. Having major depression costs the average person four months a year of lost work or the ability to function normally in social settings or on the job, the study found.

Over a lifetime, people with major depression could therefore spend 10 years under a dark cloud, says Kathleen R. Merikangas, an epidemiologist at the National Institute of Mental Health and a co-author of the study. "That's a lot of time," she adds.

It also costs a lot of money. A second study, also appearing in the journal, finds that depression costs the U.S. workforce $44 billion a year, compared to $13 billion in lost productivity time among workers without depression.

According to that study, depressed workers lost an average of 5.6 hours of productivity every week. The "expected" loss is about 1.5 hours a week, the study finds.

The good news, Merikangas says, is that treatment of depression does appear to be more common now than a decade ago. The study found that about 60 percent of people with depression saw someone -- a doctor, a psychologist, even a minister -- about their problem.

"The increased treatment also implies that there is increased recognition of depression as a disease rather than something you can just wish away or pull up your bootstraps and move on," Merikangas says.

However, only about 22 percent reported the level of treatment recommended by the government's Agency for Health Care Policy and Research and other bodies.

Although the odds of getting adequate care increased for people with severe or very severe depression, fewer than half received such treatment.

Roughly three-quarters of people who reported major depression also said they'd been diagnosed with other emotional troubles, including anxiety, drug and alcohol abuse problems, and behavior control issues. These generally appear earlier in life than depression, suggesting that if they can be controlled later mood woes might be avoided.

In 2002, the U.S. Preventive Services Task Force issued guidelines calling for routine screening of adults for depression in primary-care settings, as well as the means to accurate diagnose and adequately treat those with the condition. Dr. Alfred O. Berg, chairman of that committee, says the latest study underscores the validity of the recommendations.

"A lot of patients are not being detected and treated," says Berg, a family practice doctor at the University of Washington in Seattle. Physicians "need to have a high index of suspicion" for depression in the people who visit their offices.

"Depression is an extremely debilitating illness," says Dr. Darrel Regier, director of research for the American Psychiatric Association. The World Health Organization and the World Bank recently ranked depression the world's fourth most disabling condition, and projects it will become number two, behind only heart disease, by the year 2020. "Getting treatment for those who need it is a critical issue," Regier says.

More information

Try the National Mental Health Association or the National Institutes of Health.

SOURCES: Kathleen R. Merikangas, Ph.D., senior investigator, National Institute of Mental Health, Bethesda, Md.; Alfred O. Berg, M.D., M.P.H., chairman, U.S. Preventive Services Task Force, University of Washington, Seattle; Darrel Regier, M.D., director, research, American Psychiatric Association, Arlington, Va.; June 18, 2003, Journal of the American Medical Association
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