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What is the lifetime risk of depression?

What is the lifetime risk of depression?
  • Note that the Global Burden of Disease study found that only a quarter of geographies had primary data on the prevalence of major depression between 2005 and 2015.
    Vos, T., Allen, C., Arora, M., Barber, R. M., Bhutta, Z. A., Brown, A., Carter, A., Casey, D. C., Charlson, F. J., Chen, A. Z., Coggeshall, M., Cornaby, L., Dandona, L., Dicker, D. J., Dilegge, T., Erskine, H. E., Ferrari, A. J., Fitzmaurice, C., Fleming, T., … Murray, C. J. L. (2016). Global, regional, and national incidence, prevalence, and years lived with disability for 310 diseases and injuries, 1990–2015: A systematic analysis for the Global Burden of Disease Study 2015. The Lancet, 388(10053), 1545–1602. Appendix: page 665. https://doi.org/10.1016/S0140-6736(16)31678-6

  • A large share of the population in these countries is older than 65 years old, and studies suggest that depression becomes more common in late life. See: Luppa, M., Sikorski, C., Luck, T., Ehreke, L., Konnopka, A., Wiese, B., Weyerer, S., König, H.-H., & Riedel-Heller, S. G. (2012). Age- and gender-specific prevalence of depression in latest-life – Systematic review and meta-analysis. Journal of Affective Disorders, 136(3), 212–221. https://doi.org/10.1016/j.jad.2010.11.033. However, the studies modeling lifetime risk tend to not make estimates for older age groups.

  • Kruijshaar, M. E., Barendregt, J., Vos, T., de Graaf, R., Spijker, J., & Andrews, G. (2005). Lifetime prevalence estimates of major depression: An indirect estimation method and a quantification of recall bias. European Journal of Epidemiology, 20(1), 103–111. https://doi.org/10.1007/s10654-004-1009-0

  • An episode of major depression is defined by diagnostic manuals as the following – feeling sadness or a pronounced loss of interest for at least two weeks, along with at least five of these symptoms: fatigue, trouble concentrating, feeling excessive guilt, thoughts of death or suicide, and changes in appetite, sleep or movement.
    American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition). American Psychiatric Association. https://doi.org/10.1176/appi.books.9780890425596
    World Health Organization (Ed.). (2004). International statistical classification of diseases and related health problems (10th revision, 2nd edition). World Health Organization.
    Throughout this post, I refer to studies of the general population which used structured interviews to determine whether people had an episode of major depression to a level of a clinical diagnosis. This is important because other tools (such as screening questionnaires) to measure depression are considered less reliable; they also tend to find far higher estimates of prevalence. ​​See: Levis, B., Yan, X.W., He, C. et al. Comparison of depression prevalence estimates in meta-analyses based on screening tools and rating scales versus diagnostic interviews: a meta-research review. BMC Med 17, 65 (2019). https://doi.org/10.1186/s12916-019-1297-6
    Episodes of major depression can occur in three different conditions: major depressive disorder, persistent depressive disorder and bipolar disorder. However, most episodes of major depression occur in major depressive disorder, which is 9–10x more common than bipolar disorder. This post looks at episodes of major depression overall, which can occur in any of these disorders.
    For estimates of the risk of depression in major depressive disorder versus bipolar disorder, see: Beesdo, K., Höfler, M., Leibenluft, E., Lieb, R., Bauer, M., & Pfennig, A. (2009). Mood episodes and mood disorders: Patterns of incidence and conversion in the first three decades of life. Bipolar Disorders, 11(6), 637–649. https://pubmed.ncbi.nlm.nih.gov/19689506/

  • Mars, B., Cornish, R., Heron, J., Boyd, A., Crane, C., Hawton, K., Lewis, G., Tilling, K., Macleod, J., & Gunnell, D. (2016). Using Data Linkage to Investigate Inconsistent Reporting of Self-Harm and Questionnaire Non-Response. Archives of Suicide Research, 20(2), 113–141. https://doi.org/10.1080/13811118.2015.1033121
    Jousilahti, P. (2005). Total and cause specific mortality among participants and non-participants of population based health surveys: A comprehensive follow up of 54 372 Finnish men and women. Journal of Epidemiology & Community Health, 59(4), 310–315. https://doi.org/10.1136/jech.2004.024349
    Williams, D., & Brick, J. M. (2018). Trends in U.S. Face-To-Face Household Survey Nonresponse and Level of Effort. Journal of Survey Statistics and Methodology, 6(2), 186–211. https://doi.org/10.1093/jssam/smx019

  • Schomerus, G., Schwahn, C., Holzinger, A., Corrigan, P. W., Grabe, H. J., Carta, M. G., & Angermeyer, M. C. (2012). Evolution of public attitudes about mental illness: A systematic review and meta-analysis: Evolution of public attitudes. Acta Psychiatrica Scandinavica, 125(6), 440–452. https://doi.org/10.1111/j.1600-0447.2012.01826.x
    Angermeyer, M. C., Matschinger, H., & Schomerus, G. (2013). Attitudes towards psychiatric treatment and people with mental illness: changes over two decades. The British Journal of Psychiatry, 203(2), 146-151.

  • Ferrari, A. J., Somerville, A. J., Baxter, A. J., Norman, R., Patten, S. B., Vos, T., & Whiteford, H. A. (2013). Global variation in the prevalence and incidence of major depressive disorder: A systematic review of the epidemiological literature. Psychological Medicine, 43(3), 471–481. https://doi.org/10.1017/S0033291712001511
    Steel, Z., Marnane, C., Iranpour, C., Chey, T., Jackson, J. W., Patel, V., & Silove, D. (2014). The global prevalence of common mental disorders: A systematic review and meta-analysis 1980–2013. International Journal of Epidemiology, 43(2), 476–493. https://doi.org/10.1093/ije/dyu038

  • Vos, T., Allen, C., Arora, M., Barber, R. M., Bhutta, Z. A., Brown, A., Carter, A., Casey, D. C., Charlson, F. J., Chen, A. Z., Coggeshall, M., Cornaby, L., Dandona, L., Dicker, D. J., Dilegge, T., Erskine, H. E., Ferrari, A. J., Fitzmaurice, C., Fleming, T., … Murray, C. J. L. (2016). Global, regional, and national incidence, prevalence, and years lived with disability for 310 diseases and injuries, 1990–2015: A systematic analysis for the Global Burden of Disease Study 2015. The Lancet, 388(10053), 1545–1602. Appendix: page 665. https://doi.org/10.1016/S0140-6736(16)31678-6

  • Takayanagi, Y., Spira, A. P., Roth, K. B., Gallo, J. J., Eaton, W. W., & Mojtabai, R. (2014). Accuracy of Reports of Lifetime Mental and Physical Disorders: Results From the Baltimore Epidemiological Catchment Area Study. JAMA Psychiatry, 71(3), 273. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4135054/

  • Kessler, R. C., Petukhova, M., Sampson, N. A., Zaslavsky, A. M., & Wittchen, H.-U. (2012). Twelve-month and lifetime prevalence and lifetime morbid risk of anxiety and mood disorders in the United States. International Journal of Methods in Psychiatric Research, 21(3), 169–184.
    Moffitt, T. E., Caspi, A., Taylor, A., Kokaua, J., Milne, B. J., Polanczyk, G., & Poulton, R. (2010). How common are common mental disorders? Evidence that lifetime prevalence rates are doubled by prospective versus retrospective ascertainment. Psychological Medicine, 40(6), 899–909. https://doi.org/10.1017/S0033291709991036

  • This is similar to the way period life expectancy is calculated.

  • Kessler, R. C., Petukhova, M., Sampson, N. A., Zaslavsky, A. M., & Wittchen, H.-U. (2012). Twelve-month and lifetime prevalence and lifetime morbid risk of anxiety and mood disorders in the United States. International Journal of Methods in Psychiatric Research, 21(3), 169–184.
    This method is also useful because people are less likely to forget episodes that occurred in the past year than those that happened years ago. This study did not include estimates by gender.

  • Tam, J., Mezuk, B., Zivin, K., & Meza, R. (2020). U.S. Simulation of Lifetime Major Depressive Episode Prevalence and Recall Error. American Journal of Preventive Medicine, 59(2), e39–e47. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7375917/
    The code for this study is available at https://github.com/jamietam/dep-model-AJPM/ where you can download the data, simulate how health interventions may change the risk of lifetime depression, and more.

  • Walker, E. R., McGee, R. E., & Druss, B. G. (2015). Mortality in Mental Disorders and Global Disease Burden Implications: A Systematic Review and Meta-analysis. JAMA Psychiatry, 72(4), 334. https://doi.org/10.1001/jamapsychiatry.2014.2502

  • Kruijshaar, M. E., Barendregt, J., Vos, T., de Graaf, R., Spijker, J., & Andrews, G. (2005). Lifetime prevalence estimates of major depression: An indirect estimation method and a quantification of recall bias. European Journal of Epidemiology, 20(1), 103–111. https://link.springer.com/article/10.1007/s10654-004-1009-0

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