Comorbidity of DSM–III–R Major Depressive Disorder in the General Population: Results from the US National Comorbidity Survey

Abstract

General population data are presented on the prevalence and correlates of comorbidity between DSM–III–R major depressive disorder (MDD) and other DSM–III–R disorders. The data come from the US National Comorbidity Survey, a large general population survey of persons aged 15–54 years in the non-institutionalised civilian population. Diagnoses are based on a modified version of the Composite International Diagnostic Interview (CIDI). The analysis shows that most cases of lifetime MDD are secondary, in the sense that they occur in people with a prior history of another DSM–III–R disorder. Anxiety disorders are the most common primary disorders. The time-lagged effects of most primary disorders on the risk of subsequent MDD continue for many years without change in magnitude. Secondary MDD is, in general, more persistent and severe than pure or primary MDD. This has special public health significance because lifetime prevalence of secondary MDD has increased in recent cohorts, while the prevalence of pure and primary depression has remained unchanged.

Maternal, not paternal, PTSD is related to increased risk for PTSD in offspring of Holocaust survivors

“…Accordingly, differences between the comparison subjects in this sample and others might reflect this selection bias. A major difference between this and other published reports of the prevalence of psychiatric disorders in the community is the absence of significant gender differences in mood and anxiety disorders (Breslau et al, 1997;Kessler et al, 1996), though the rates of psychiatric disorders in the current comparison group are comparable to those reported in the recent replication of the National Comorbidity Study. That study reported a population prevalence of depressive disorder of 16.4% compared to the current sample's prevalence of 17.6% in comparison subjects (Kessler et al, 2003).…”

Risk for recurrence in depression

“…Third, studies have varied in whether they include only individuals with unipolar depression, or whether they also include those with bipolar disorder who have experienced recurrent depressive episodes; this difference may account for some of the divergent findings reviewed in this paper, especially in studies using clinical samples where rates of bipolar disorder are often higher. Fourth, studies have varied in whether they include individuals with only unipolar depression and no comorbid psychopathology, which represent unusually "clean" cases of depression that are not representative of the general population of individuals with depression (Kessler et al, 1996). Alternatively, some studies only examine hospital readmission rates, which may represent only unusually severe cases of depression and may be missing the presence of less severe recurrent episodes which do not lead to re-hospitalization.…”

“…For example, it could be that the affective disorders alone are responsible for the connection between family history of psychopathology and recurrence of depression; alternatively it could be that anxiety disorders or substance use disorders, for example, are also related to recurrence. In addition, studies of this type must be performed on genetically informative samples in order to account for the high comorbidity and familial liability between depression and other forms of psychopathology (Burcusa, Iacono, & McGue, 2003;Kendler et al, 1995;Kessler et al, 1996;Krueger, 1999).…”

“…For example, it could be that the affective disorders alone are responsible for the connection between family history of psychopathology and recurrence of depression; alternatively it could be that anxiety disorders or substance use disorders, for example, are also related to recurrence. In addition, studies of this type must be performed on genetically informative samples in order to account for the high comorbidity and familial liability between depression and other forms of psychopathology (Burcusa, Iacono, & McGue, 2003;Kendler et al, 1995;Kessler et al, 1996;Krueger, 1999).There are different mechanisms through which a family history of psychopathology could be related to recurrence of depression. The results of family studies suggest that the familial transmission of recurrent depression is even stronger than the familial transmission of depression in general (Klein, Lewinsohn, Rohde, Seeley, & Durbin, 2002;Zubenko et al, 2001), particularly if it is early-onset recurrent depression (Moldin, Reich, & Rice, 1991).…”

Clinical significance and comorbidity of subthreshold depression and anxiety in the community

“…These studies reveal increased symptom severity (24±28), and poorer treatment compliance (29) and outcome (29±31) among those with comorbid compared tò pure' disorders. The majority of follow-up studies of clinical samples as well as population-based research with retrospective course assessment also found comorbidity to be a predictor of suicide (32) or suicide attempts (33), social disabilitiy (27, 30, 31, 34±36) and treatment need (14,30,36).…”