Cross-national epidemiology of DSM-IV major depressive episode
Bromet, E and Andrade, LH and Hwang, I and Sampson, NA and Alonso, J and de Girolamo, G and de Graaf, R and Demyttenaere, K and Hu, C and Iwata, N and Karam, AN and Kaur, J and Kostyuchenko, S and Lepine, J and Levinson, D and Matschinger, H and Mora, MEM and Oakley Browne, MA and Posada-Villa, J and Viana, MC and Williams, DR and Kessler, RC, Cross-national epidemiology of DSM-IV major depressive episode, BMC Medicine, 9 Article 90. ISSN 1741-7015 (2011) [Refereed Article]
Background: Major depression is one of the leading causes of disability worldwide, yet epidemiologic data are not
available for many countries, particularly low- to middle-income countries. In this paper, we present data on the
prevalence, impairment and demographic correlates of depression from 18 high and low- to middle-income
countries in the World Mental Health Survey Initiative.
Methods: Major depressive episodes (MDE) as defined by the Diagnostic and Statistical Manual of Mental Disorders,
fourth edition (DMS-IV) were evaluated in face-to-face interviews using the World Health Organization Composite
International Diagnostic Interview (CIDI). Data from 18 countries were analyzed in this report (n = 89,037). All
countries surveyed representative, population-based samples of adults.
Results: The average lifetime and 12-month prevalence estimates of DSM-IV MDE were 14.6% and 5.5% in the ten
high-income and 11.1% and 5.9% in the eight low- to middle-income countries. The average age of onset
ascertained retrospectively was 25.7 in the high-income and 24.0 in low- to middle-income countries. Functional
impairment was associated with recency of MDE. The female: male ratio was about 2:1. In high-income countries,
younger age was associated with higher 12-month prevalence; by contrast, in several low- to middle-income
countries, older age was associated with greater likelihood of MDE. The strongest demographic correlate in highincome
countries was being separated from a partner, and in low- to middle-income countries, was being
divorced or widowed.
Conclusions: MDE is a significant public-health concern across all regions of the world and is strongly linked to
social conditions. Future research is needed to investigate the combination of demographic risk factors that are
most strongly associated with MDE in the specific countries included in the WMH