Research report
Prevalence and correlates of DSM-IV major depression in an Australian national survey

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Abstract

Background: Community surveys have reported prevalence of depressive disorders in adult populations since the 1970s. Until recently, no epidemiological studies of the same magnitude have been conducted to provide a profile of the adult population in Australia. This study examines the current (30-day) prevalence and correlates of major depression in the adult Australian population using data from the National Survey of Mental Health and Well-being, and compares the results with other national studies. Methods: Data were derived from a national sample of 10 641 people 18–75+ years of age surveyed using the computerised version of the Composite International Diagnostic Interview Version 2.1. Results: The overall weighted prevalence of current (30-day) major depression was 3.2% with the highest rate (5.2%) being found in females in mid life. This rate is between those of the USA National Comorbidity Survey and the Epidemiological Catchment Area study, and similar to the British Psychiatric Morbidity Survey. The strongest correlates for reported current major depression include being unemployed, smoking, having a medical condition, followed by being in mid life, previously married, and female. Living with a partner and drinking 1 to 2 glasses of alcohol per day were least correlated. Some correlates of major depression relate to social disadvantage and lifestyle issues. Limitations: The study design does not allow definition of direction of causality. Conclusion: Lowering the prevalence rate of major depression will require close attention to public health approaches to address the relationships between smoking, social isolation, poor health, mood and physical well-being. The best focus for this approach may be primary care settings.

Introduction

Over the past two decades, there has been growing interest in the estimation of prevalence of depressive disorders in the general community. The first estimates of major depression and dysthymia were reported for the Epidemiologic Catchment Area (ECA) study (Regier et al., 1984), which used the Diagnostic Interview Schedule (DIS) based on DSM-III diagnoses (Robins et al., 1981). The ECA prevalence estimates of major depression were questioned because the estimates were lower than previous studies (Parker, 1987). The USA National Comorbidity Survey (NCS) (Blazer et al., 1994) represented the first epidemiological data from a national sample of community residents from which estimates of prevalence distribution and risk factors for selected DSM-III-R psychiatric disorders could be derived. It was designed to improve on methodology used in the ECA study and used the Composite International Diagnostic Interview (CIDI) Version 1.1. The NCS attempted to improve lifetime case detection rates with the use of ‘commitment’ and ‘motivation’ probes and by weighting for undetected cases among non-respondents. The British Psychiatric Morbidity Survey (BPMS), also a national community study, utilised the Revised Clinical Interview Schedule (CIS-R), an alternative lay-administered diagnostic interview to measure rates for ICD-10 categories (Brugha et al., 1999).

To determine the prevalence of mental disorders in the Australian population, the Australian Government financed a national survey (Australian Bureau of Statistics, 1998). The household survey of a population sample of adults aged 18 years and over, using the CIDI Version 2.1 as the case-finding instrument, was closely modeled on the USA NCS cross-sectional study.

We have examined these data to address the following questions:

  • 1.

    What are the current (30-day) prevalence rates for major depression? Do the Australian rates compare with other comparable national studies?

  • 2.

    Are there gender differences in current prevalence rates for depression?

  • 3.

    What is the relationship between current prevalence rates of major depression and disability, demographic, behavioural and physical illness variables?

Section snippets

Description of sample

The National Survey of Mental Health and Well-being (NSMHWB) sampled adults in urban and rural areas of Australia. It was conducted by the Australian Bureau of Statistics (1998) using the computerised version of the Composite International Diagnostic Interview (CIDI) Version 2.1 (WHO, 1996). More details on the design of the NSMHWB are presented elsewhere (Andrews et al., 2001). Interviewers, trained by the WHO Training and Reference Centre for CIDI in Sydney, were employed by the ABS to

Prevalence of major depression

The total prevalence rate of DSM-IV MD was 3.2% (males 2.4%, females 3.9%) with the highest rate for females in mid life (Table 1). The ICD-10 rate was very similar at 3.3% (males 2.4%, females 4.2%).

Disability

The disability associated with MD, as measured from the SF-12 scale, showed greater mental disability for both males and females in mid life, and greater physical disability for both males and females in later life. The highest mean days spent ‘out of role’ for males was 7.1 days in later life, and

Relationship of major depression to age, gender and socioeconomic status

The current (30-day) weighted prevalence rate for MD in Australia, as assessed by the NSMHWB, was 3.2%. The prevalence of DSM-IIIR depression in the NCS was 4.9% (Blazer et al., 1994) and 2.2% for DSM-III cases in the ECA study (Regier et al., 1993). Women had higher rates of depression in all three studies. However, we found that disability scores showed a different picture. While scores varied with age, the experience for both sexes on mental and physical scales was very similar, with no

Acknowledgements

This paper was supported by a contract from the Australian Department of Health and Aged Services to the WHO Collaborating Centre for Mental Health, Sydney, to support a survey data analysis consortium (G. Andrews, V. Carr, G. Carter, R. Crino, W. Hall, A. Henderson, I. Hickie, C. Hunt, L. Lampe, J. McGrath, A. McFarlane, P. Mitchell, L. Peters, M. Teesson, K. Wilhelm) and also by NH&MRC Program Grant 993208. We thank those members of the Australian population who willingly participated in the

References (29)

  • S. Centanni et al.

    Psychological issues in the treatment of asthmatic patients

    Respir. Med.

    (2000)
  • B.N. Leistikow et al.

    Smoking as a risk factor for injury death: A meta-analysis of cohort studies

    Prev. Med.

    (1998)
  • M.M. Ohayon et al.

    The prevalence of depressive disorders in the United Kingdom

    Biol. Psychiatry

    (1999)
  • G. Andrews et al.

    Prevalence, comorbidity, disability and service utilisation: An overview of the Australian National Mental Health Survey

    Br. J. Psychiatry

    (2001)
  • Australian Bureau of Statistics, 1998. Mental health and well-being: Profile of adults of Australia, 1997. Australian...
  • P. Bebbington

    Sex and depression

    Psychol. Med.

    (1998)
  • D.G. Blazer et al.

    The prevalence and distribution of major depression in a national community sample: The National Comorbidity Survey

    Am. J. Psychiatry

    (1994)
  • N. Breslau et al.

    Major depression and stages of smoking: A longitudinal investigation

    Arch. Gen. Psychiatry

    (1998)
  • T. Brugha et al.

    The survey form of SCAN: the feasibility of using experienced lay survey interviewers to administer a semi-structured systematic clinical assessment of psychotic and non-psychotic disorders

    Psychol. Med.

    (1999)
  • L.S. Covey et al.

    Cigarette smoking and major depression

    J. Addict. Dis.

    (1998)
  • D.E. Ford et al.

    Depression is a risk factor for coronary artery disease in men: The precursors study

    Arch. Intern. Med.

    (1998)
  • A.S. Henderson et al.

    Symptoms of depression and anxiety during adult life: evidence for a decline in prevalence with age

    Psychol. Med.

    (1998)
  • A.F. Jorm et al.

    Smoking and mental health: Results from a community survey

    Med. J. Aust.

    (1999)
  • A. Jorm

    Does old age reduce the risk of anxiety and depression? A review of epidemiological studies across the adult life span

    Psychol. Med.

    (2000)
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