Unit 6 epidemiology depression and suicide

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Unit 6 epidemiology depression and suicide

  1. 1. The Epidemiology of Depression
  2. 2. Lifetime Prevalence of Major Depressive Disorder by Age Source: Kessler RC et al. Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication. Arch Gen Psychiatry 62:593-602. <ul><li>Compared to adults over the age of 60 years, </li></ul><ul><ul><li>18-29 year olds are 70% more likely to have experienced depression over their lifetime </li></ul></ul><ul><ul><li>30-44 year olds are 120% more likely </li></ul></ul><ul><ul><li>45-49 year olds are 100% more likely </li></ul></ul><ul><li>While major depression is less common among the elderly, 12-20% suffer from some depressive symptoms </li></ul>Total (%) 18-29 (%) 30-44 (%) 45-59 (%) 60+ Major depressive disorder 16.6 15.4 19.8 18.8 10.6
  3. 3. Twelve-Month Prevalence of Major Depressive Disorder by Severity Source: Kessler RC et al. Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication. Arch Gen Psychiatry 62:593-602. Total (%) Serious (% of all cases) Moderate (% of all cases) Mild (% of all cases) Major depressive disorder 6.7 30.4 50.1 19.5
  4. 4. Incidence and Age of Onset (AOO) <ul><li>First onset incidence: 1.6 per 100 </li></ul><ul><li>Average age of onset: 32 years old </li></ul>Source: National Institute of Mental Health.
  5. 5. Subtypes of Major Depression <ul><li>Subtypes </li></ul><ul><ul><li>Major depression with psychotic features (~14% of depression) </li></ul></ul><ul><ul><ul><li>More severe course than nonpsychotic depression </li></ul></ul></ul><ul><ul><ul><li>Increased risk of relapse, persistence over one year, suicide attempts, hospitalization, comorbidity, financial dependency </li></ul></ul></ul><ul><ul><li>Major depression with atypical features </li></ul></ul><ul><ul><ul><li>E.g., overeating and oversleeping </li></ul></ul></ul><ul><ul><ul><li>Younger age of onset, more psychomotor slowing, more comorbid panic disorder, drug abuse/dependence, and somatization disorder relative to depression without atypical features </li></ul></ul></ul>Source: Horwath, Cohen, Weissman. Epidemiology of Depressive and Anxiety Disorders. In: Textbook in Psychiatric Epidemiology , MT Tsuang and M Tohen, eds. (2 nd edition). Wiley-Liss, 2002: New York.
  6. 6. The Global Burden of Disease <ul><li>The Global Burden of Disease Study conducted by the World Health Organization found that depression was one of the most disabling diseases in the world </li></ul><ul><ul><li>Due to the number of Disability-Adjusted Life Years (DALYs) and Years of Life Lost (YLL) associated with the disease, depression ranked as the fourth most disabling disease in the world </li></ul></ul>Source: Horwath, Cohen, Weissman. Epidemiology of Depressive and Anxiety Disorders. In: Textbook in Psychiatric Epidemiology , MT Tsuang and M Tohen, eds. (2 nd edition). Wiley-Liss, 2002: New York.
  7. 7. Sociodemographic Factors Associated with Depression <ul><li>Women are 70% more likely than men to experience depression during their lifetime </li></ul><ul><li>Non-Hispanic blacks are 40% less likely than non-Hispanic whites to experience depression during their lifetime </li></ul><ul><li>Age is associated with depression, with the strongest association among 30-44 year olds </li></ul><ul><li>Lower level of education and employment classification </li></ul><ul><ul><li>Homemakers </li></ul></ul><ul><li>Separated, divorced, or widowed </li></ul>Sources: National Institute of Mental Health
  8. 8. Family History <ul><li>Depression tends to cluster in families </li></ul><ul><li>First-degree relatives of individuals with major depression have a 2-3 fold increased risk of disease </li></ul><ul><li>Concordance of depression is higher in monozygotic twin pairs (27%) relative to dizygotic twin pairs (12%), suggesting a genetic contribution </li></ul>Source: Horwath, Cohen, Weissman. Epidemiology of Depressive and Anxiety Disorders. In: Textbook in Psychiatric Epidemiology , MT Tsuang and M Tohen, eds. (2 nd edition). Wiley-Liss, 2002: New York.
  9. 9. Comorbid Conditions <ul><li>Dysthymic disorder is associated with a five-fold increase of depression </li></ul><ul><li>Schizophrenia is associated with ~3-fold increase in first-onset major depression </li></ul><ul><li>50-60% of individuals with a lifetime history of major depression have a history of one or more anxiety disorders </li></ul>Source: Horwath, Cohen, Weissman. Epidemiology of Depressive and Anxiety Disorders. In: Textbook in Psychiatric Epidemiology , MT Tsuang and M Tohen, eds. (2 nd edition). Wiley-Liss, 2002: New York.
  10. 10. Suicide <ul><li>In 2007, suicide was the tenth leading cause of death in the United States </li></ul><ul><ul><li>Third leading cause of death for young people ages 15-24 years </li></ul></ul><ul><li>There are an estimated 11 attempted suicides per every suicide death </li></ul>Source: National Institute of Mental Health
  11. 11. Risk Factors for Suicide <ul><li>Depression and other mental disorders, substance-abuse disorder </li></ul><ul><li>Prior suicide attempt </li></ul><ul><li>Family history of mental disorder or substance abuse, suicide </li></ul><ul><li>Family violence </li></ul><ul><li>Firearms in the home (used in more than half of suicides) </li></ul><ul><li>Incarceration </li></ul><ul><li>Exposure to the suicidal behavior of others (family, peers, or media figures) </li></ul>Source: National Institute of Mental Health
  12. 12. Sociodemographic Factors Associated with Suicide <ul><li>Highest rates among American Indian and Alaska Natives (14.3 per 100,000) and Non-Hispanic Whites (13.5 per 100,000) </li></ul><ul><li>Lower rates among Asian and Pacific Islanders (6.2 per 100,000); Hispanics (6.0 per 100,000); non-Hispanic Blacks (5.1 per 100,000) </li></ul>Source: National Institute of Mental Health
  13. 13. Risk Factors for Suicide <ul><li>~4 times as many men as women die by suicide </li></ul><ul><li>Firearms, suffocation, and poison are the most common methods of suicide </li></ul><ul><ul><li>Firearms are used in 56% of male suicides, 30% of female suicides </li></ul></ul><ul><ul><li>Poisoning is used in 40% of female suicides, 13% of male suicides </li></ul></ul>Source: National Institute of Mental Health
  14. 15. Suicide Rates in the United States

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