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Depressive Symptoms as Relative and Attributable Risk Factors for First-Onset Major Depression

Depressive Symptoms as Relative and Attributable Risk Factors for First-Onset Major Depression Abstract • Using longitudinal data from a community study of 9900 adults drawn from four sites in the United States and interviewed twice, 1 year apart, we investigated the predictors of first-onset major depression. Using odds ratios to estimate relative risk, we found that persons with depressive symptoms, compared with those without such symptoms, were 4.4 times more likely and persons with dysthymia were 5.5 times more likely to develop a first-onset major depression during a 1-year period. The lifetime prevalence rate for depressive symptoms was 24%. The attributable risk is a compound epidemiologic measure that reflects both the relative risk associated with depressive symptoms (4.4) and the prevalence of exposure to that risk (24%). It is a useful measure to document the burden of a risk to the community, and it was determined to be greater than 50%. Thus, more than 50% of cases of first-onset major depression are associated with prior depressive symptoms. The high prevalence of depressive symptoms in the community and their strong association with first-onset major depression make them important from a public health perspective. Because depressive symptoms are often unrecognized and untreated in clinical practice, we conclude that their identification and the development of effective treatments could have implications for the prevention of major depression. References 1. Boyd JH, Weissman MM. Epidemiology of affective disorders: a reexamination and future directions . Arch Gen Psychiatry . 1981;38:1039-1046.Crossref 2. Klerman GL. Depressive disorders: further evidence for increased medical morbidity and impairment of social functioning . Arch Gen Psychiatry . 1989;46:856-858.Crossref 3. Wells KB, Stewart A, Hays RD, Burnam MA, Rogers W, Daniels M, Berry S, Greenfields, Ware J. The functioning and well-being of depressed patients: results from the Medical Outcomes Study . JAMA . 1989;262:914-919.Crossref 4. Broadhead WE, Blazer DG, George LK, Tse CK. Depression, disability days, and days lost from work in a prospective epidemiologic survey . JAMA . 1990;264:2524-2528.Crossref 5. Essen-Moller E, Hagnell O. The frequency and risk of depression within a rural group in Scania . Acta Psychiatr Scand . 1961;162( (suppl) ):28-32. 6. Hallstrom T; Jacobs A, trans. Mental disorder and sexuality in the climacteric: a study in psychiatric epidemiology . In: Forsman E, ed. Reports From the Psychiatric Research Centre, St. Jorgan's Hospital, University of Goteborg, Sweden . Copenhagen, Denmark: Scandinavian University Books; 1973;6. 7. Brown GW, Harris T. Social Origins of Depression: A Study of Psychiatric Disorder in Women . London, England: Tavistock Publications; 1978. 8. Eaton WW, Kramer M, Anthony JC, Dryman A, Shapiro S, Locke BZ. The incidence of specific DIS/DSM-III mental disorders: data from the NIMH Epidemiologic Catchment Area Program . Acta Psychiatr Scand . 1989;79:163-176.Crossref 9. Anthony JC, Petronis KR. Suspected risk factors for depression among adults 18-44 years old . Epidemiology . 1991;2:123-132.Crossref 10. Goldberg D, Steele J, Smith C, Spivey L. Training family doctors to recognize psychiatric illness with increased accuracy . Lancet . 1980;2:521-523.Crossref 11. Mausner JS, Bahn AK. Epidemiology . Philadelphia, Pa: WB Saunders Co; 1974:322-324. 12. Doll R, Hill AB. Lung cancer and other causes of death in relation to smoking . BMJ . (November 10) , 1956:1071-1081. 13. Kelsey JL, Thompson WD, Evans AS. Methods in Observational Epidemiology . New York, NY: Oxford University Press; 1986. 14. Julius S, Jamerson K, Mejia A, Krause L, Schork N, Jones K. The association of borderline hypertension with target organ changes and higher coronary risk . JAMA . 1990;264:354-358.Crossref 15. Eaton WW, Kessler LG. Epidemiologic Field Methods in Psychiatry: The NIMH Epidemiologic Catchment Area Program . Orlando, Fla: Academic Press Inc; 1985. 16. Regier DA, Myers JK, Kramer M, Robins LN, Blazer DG, Hough RL, Eaton WW, Locke BZ. The NIMH Epidemiologic Catchment Area Program: historical context, major obstacles, and study population characteristics . Arch Gen Psychiatry . 1984;41:934-941.Crossref 17. Robins LN, Helzer JE, Croughan JL, Ratcliff KS. The NIMH Diagnostic Interview Schedule: its history, characteristics, and validity . Arch Gen Psychiatry . 1981;38:381-389.Crossref 18. Weissman MM, Bruce ML, Leaf PJ, Florio LP, Holzer C. Affective disorders . In: Robins LN, Regier DE, eds. Psychiatric Disorders in America . New York, NY: The Free Press; 1991. 19. Greenland S. Bias in methods for deriving standardized morbidity ratio and attributable fraction estimates . Stat Med . 1984;3:131-141.Crossref 20. Akiskal HS. Subaffective disorders: Dysthymic, cyclothymic and bipolar II disorders in the 'borderline' realm . Psychiatr Clin North Am . 1981; 4:25-46. 21. Siris SG, Morgan V, Fagerstrom R, Rifkin A, Cooper TB. Adjunctive imipramine in the treatment of postpsychotic depression: a controlled trial . Arch Gen Psychiatry . 1987;44:533-539.Crossref 22. Cohen P, Cohen J. The clinician's illusion . Arch Gen Psychiatry . 1984;41:1178-1182.Crossref 23. Weissman MM, Leaf PJ, Tischler GL, Blazer DG, Karno M, Bruce ML, Florio LP. Affective disorders in five United States communities . Psychol Med . 1988;18:141-153.Crossref 24. Myers JK, Weissman MM, Tischler GL, Holzer CE, Leaf PJ, Orvaschel H, Anthony JC, Boyd JH, Burke JD, Kramer M, Stoltzman R. Six-month prevalence of psychiatric disorders in three communities . Arch Gen Psychiatry . 1984;41:959-967.Crossref 25. Burnam MA, Hough RI, Karno M, Escobar JI, Telles CA. Acculturation and lifetime prevalence of psychiatric disorders among Mexican-Americans in Los Angeles . J Health Soc Behav . 1987;28:89-102.Crossref 26. Akiskal HS, McKinney WT. Depressive disorders: toward a unified hypothesis: clinical, experimental, genetic, biochemical, and neurophysiological data are integrated . Science . 1973;182:20-29.Crossref 27. Cooke DJ, Hole DJ. The aetiological importance of stressful life events . Br J Psychiatry . 1983;143:397-400.Crossref 28. Weissman MM, Gershon ES, Kidd KK, Prusoff BA, Leckman JF, Dibble E, Hamovit J, Thompson WD, Pauls DL, Guroff JJ. Psychiatric disorder in relatives of probands with affective disorders: the Yale-NIMH collaborative family study . Arch Gen Psychiatry . 1984;41:13-21.Crossref 29. Dunn JE. Preliminary findings of the Memphis-Shelby County uterine cancer study and their interpretation . Am J Public Health . 1958;48:861-873.Crossref 30. Shepherd M, Cooper B, Brown AC, Kalton G. Psychiatric Illness in General Practice . 2nd ed. Oxford, England: Oxford University Press; 1981 31. Regier DA, Goldberg ID, Taube CA. The de facto US mental health services system . Arch Gen Psychiatry . 1978;35:685-693.Crossref 32. Goldberg D. Detection and assessment of emotional disorders in a primary care setting . Int J Ment Health . 1979;8:30-48. 33. Clare AW, Blacker R. Some problems affecting the diagnosis and classification of depressive disorders in primary care . In: Shepherd M, Wilkinson G, Williams P, eds. Mental Illness in Primary Care Settings . London, England: Tavistock Publications; 1986. 34. Marks J, Goldberg D, Hillier VF. Determinants of the ability of general practitioners to detect psychiatric illness . Psychol Med . 1979;9:337-354.Crossref 35. Sharp D, Morrell D. The psychiatry of general practice . In: Williams P, Wilkinson G, Rawnsley K, eds. The Scope of Epidemiologic Psychiatry: Essays in Honour of Michael Shepherd . London, England: Routledge & Kegan Paul; 1989. 36. Klerman GL, Budman S, Berwick D, Weissman MM, Damico-White J, Demby A, Feldstein M. Efficacy of a brief psychosocial intervention for symptoms of stress and distress among patients in primary care . Med Care . 1987;25:1078-1088.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of General Psychiatry American Medical Association

Depressive Symptoms as Relative and Attributable Risk Factors for First-Onset Major Depression

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Publisher
American Medical Association
Copyright
Copyright © 1992 American Medical Association. All Rights Reserved.
ISSN
0003-990X
eISSN
1598-3636
DOI
10.1001/archpsyc.1992.01820100061011
Publisher site
See Article on Publisher Site

Abstract

Abstract • Using longitudinal data from a community study of 9900 adults drawn from four sites in the United States and interviewed twice, 1 year apart, we investigated the predictors of first-onset major depression. Using odds ratios to estimate relative risk, we found that persons with depressive symptoms, compared with those without such symptoms, were 4.4 times more likely and persons with dysthymia were 5.5 times more likely to develop a first-onset major depression during a 1-year period. The lifetime prevalence rate for depressive symptoms was 24%. The attributable risk is a compound epidemiologic measure that reflects both the relative risk associated with depressive symptoms (4.4) and the prevalence of exposure to that risk (24%). It is a useful measure to document the burden of a risk to the community, and it was determined to be greater than 50%. Thus, more than 50% of cases of first-onset major depression are associated with prior depressive symptoms. The high prevalence of depressive symptoms in the community and their strong association with first-onset major depression make them important from a public health perspective. Because depressive symptoms are often unrecognized and untreated in clinical practice, we conclude that their identification and the development of effective treatments could have implications for the prevention of major depression. References 1. Boyd JH, Weissman MM. Epidemiology of affective disorders: a reexamination and future directions . Arch Gen Psychiatry . 1981;38:1039-1046.Crossref 2. Klerman GL. Depressive disorders: further evidence for increased medical morbidity and impairment of social functioning . Arch Gen Psychiatry . 1989;46:856-858.Crossref 3. Wells KB, Stewart A, Hays RD, Burnam MA, Rogers W, Daniels M, Berry S, Greenfields, Ware J. The functioning and well-being of depressed patients: results from the Medical Outcomes Study . JAMA . 1989;262:914-919.Crossref 4. Broadhead WE, Blazer DG, George LK, Tse CK. Depression, disability days, and days lost from work in a prospective epidemiologic survey . JAMA . 1990;264:2524-2528.Crossref 5. Essen-Moller E, Hagnell O. The frequency and risk of depression within a rural group in Scania . Acta Psychiatr Scand . 1961;162( (suppl) ):28-32. 6. Hallstrom T; Jacobs A, trans. Mental disorder and sexuality in the climacteric: a study in psychiatric epidemiology . In: Forsman E, ed. Reports From the Psychiatric Research Centre, St. Jorgan's Hospital, University of Goteborg, Sweden . Copenhagen, Denmark: Scandinavian University Books; 1973;6. 7. Brown GW, Harris T. Social Origins of Depression: A Study of Psychiatric Disorder in Women . London, England: Tavistock Publications; 1978. 8. Eaton WW, Kramer M, Anthony JC, Dryman A, Shapiro S, Locke BZ. The incidence of specific DIS/DSM-III mental disorders: data from the NIMH Epidemiologic Catchment Area Program . Acta Psychiatr Scand . 1989;79:163-176.Crossref 9. Anthony JC, Petronis KR. Suspected risk factors for depression among adults 18-44 years old . Epidemiology . 1991;2:123-132.Crossref 10. Goldberg D, Steele J, Smith C, Spivey L. Training family doctors to recognize psychiatric illness with increased accuracy . Lancet . 1980;2:521-523.Crossref 11. Mausner JS, Bahn AK. Epidemiology . Philadelphia, Pa: WB Saunders Co; 1974:322-324. 12. Doll R, Hill AB. Lung cancer and other causes of death in relation to smoking . BMJ . (November 10) , 1956:1071-1081. 13. Kelsey JL, Thompson WD, Evans AS. Methods in Observational Epidemiology . New York, NY: Oxford University Press; 1986. 14. Julius S, Jamerson K, Mejia A, Krause L, Schork N, Jones K. The association of borderline hypertension with target organ changes and higher coronary risk . JAMA . 1990;264:354-358.Crossref 15. Eaton WW, Kessler LG. Epidemiologic Field Methods in Psychiatry: The NIMH Epidemiologic Catchment Area Program . Orlando, Fla: Academic Press Inc; 1985. 16. Regier DA, Myers JK, Kramer M, Robins LN, Blazer DG, Hough RL, Eaton WW, Locke BZ. The NIMH Epidemiologic Catchment Area Program: historical context, major obstacles, and study population characteristics . Arch Gen Psychiatry . 1984;41:934-941.Crossref 17. Robins LN, Helzer JE, Croughan JL, Ratcliff KS. The NIMH Diagnostic Interview Schedule: its history, characteristics, and validity . Arch Gen Psychiatry . 1981;38:381-389.Crossref 18. Weissman MM, Bruce ML, Leaf PJ, Florio LP, Holzer C. Affective disorders . In: Robins LN, Regier DE, eds. Psychiatric Disorders in America . New York, NY: The Free Press; 1991. 19. Greenland S. Bias in methods for deriving standardized morbidity ratio and attributable fraction estimates . Stat Med . 1984;3:131-141.Crossref 20. Akiskal HS. Subaffective disorders: Dysthymic, cyclothymic and bipolar II disorders in the 'borderline' realm . Psychiatr Clin North Am . 1981; 4:25-46. 21. Siris SG, Morgan V, Fagerstrom R, Rifkin A, Cooper TB. Adjunctive imipramine in the treatment of postpsychotic depression: a controlled trial . Arch Gen Psychiatry . 1987;44:533-539.Crossref 22. Cohen P, Cohen J. The clinician's illusion . Arch Gen Psychiatry . 1984;41:1178-1182.Crossref 23. Weissman MM, Leaf PJ, Tischler GL, Blazer DG, Karno M, Bruce ML, Florio LP. Affective disorders in five United States communities . Psychol Med . 1988;18:141-153.Crossref 24. Myers JK, Weissman MM, Tischler GL, Holzer CE, Leaf PJ, Orvaschel H, Anthony JC, Boyd JH, Burke JD, Kramer M, Stoltzman R. Six-month prevalence of psychiatric disorders in three communities . Arch Gen Psychiatry . 1984;41:959-967.Crossref 25. Burnam MA, Hough RI, Karno M, Escobar JI, Telles CA. Acculturation and lifetime prevalence of psychiatric disorders among Mexican-Americans in Los Angeles . J Health Soc Behav . 1987;28:89-102.Crossref 26. Akiskal HS, McKinney WT. Depressive disorders: toward a unified hypothesis: clinical, experimental, genetic, biochemical, and neurophysiological data are integrated . Science . 1973;182:20-29.Crossref 27. Cooke DJ, Hole DJ. The aetiological importance of stressful life events . Br J Psychiatry . 1983;143:397-400.Crossref 28. Weissman MM, Gershon ES, Kidd KK, Prusoff BA, Leckman JF, Dibble E, Hamovit J, Thompson WD, Pauls DL, Guroff JJ. Psychiatric disorder in relatives of probands with affective disorders: the Yale-NIMH collaborative family study . Arch Gen Psychiatry . 1984;41:13-21.Crossref 29. Dunn JE. Preliminary findings of the Memphis-Shelby County uterine cancer study and their interpretation . Am J Public Health . 1958;48:861-873.Crossref 30. Shepherd M, Cooper B, Brown AC, Kalton G. Psychiatric Illness in General Practice . 2nd ed. Oxford, England: Oxford University Press; 1981 31. Regier DA, Goldberg ID, Taube CA. The de facto US mental health services system . Arch Gen Psychiatry . 1978;35:685-693.Crossref 32. Goldberg D. Detection and assessment of emotional disorders in a primary care setting . Int J Ment Health . 1979;8:30-48. 33. Clare AW, Blacker R. Some problems affecting the diagnosis and classification of depressive disorders in primary care . In: Shepherd M, Wilkinson G, Williams P, eds. Mental Illness in Primary Care Settings . London, England: Tavistock Publications; 1986. 34. Marks J, Goldberg D, Hillier VF. Determinants of the ability of general practitioners to detect psychiatric illness . Psychol Med . 1979;9:337-354.Crossref 35. Sharp D, Morrell D. The psychiatry of general practice . In: Williams P, Wilkinson G, Rawnsley K, eds. The Scope of Epidemiologic Psychiatry: Essays in Honour of Michael Shepherd . London, England: Routledge & Kegan Paul; 1989. 36. Klerman GL, Budman S, Berwick D, Weissman MM, Damico-White J, Demby A, Feldstein M. Efficacy of a brief psychosocial intervention for symptoms of stress and distress among patients in primary care . Med Care . 1987;25:1078-1088.Crossref

Journal

Archives of General PsychiatryAmerican Medical Association

Published: Oct 1, 1992

References