The prevalence of depressive disorders in the united kingdom

doi:10.1016/S0006-3223(98)00011-0

Biological Psychiatry

Volume 45, Issue 3, 1 February 1999, Pages 300-307

https://doi.org/10.1016/S0006-3223(98)00011-0 Get rights and content

Abstract

Background: The prevalence of major psychiatric disorders in the general population is difficult to pinpoint owing to widely divergent estimates yielded by studies employing different criteria, methods, and instruments. Depressive disorders, which represent a sizable mental health care expense for the public purse, are no exception to the rule.

Methods: The prevalence of depressive disorders was assessed in a representative sample (n = 4972) of the U.K. general population in 1994. Interviews were performed over the telephone by lay interviewers using an expert system that tailored the questionnaire to each individual based on prior responses. Diagnoses and symptoms lists were based on the DSM-IV.

Results: Five percent (95% confidence interval = 4.4–5.6%) of the sample was diagnosed by the system with a depressive disorder at the time of the interview, with the rate slightly higher for women (5.9%) than men (4.2%). Unemployed, separated, divorced, and widowed individuals were found to be at higher risk for depression. Depressive subjects were seen almost exclusively by general practitioners (only 3.4% by psychiatrists). Only 12.5% of them consulted their physician seeking mental health treatment, and 15.9% reported being hospitalized in the past 12 months.

Conclusions: The study indicates that mental health problems in the community are seriously underdetected by general practitioners, and that these professionals are highly reluctant to refer patients with depressive disorders to the appropriate specialist.

Introduction

The prevalence of major psychiatric disorders in the general population is difficult to pinpoint owing to widely divergent estimates yielded by studies employing different criteria, methods, and instruments. Depressive disorders, which represent a sizable mental health care expense for the public purse, are no exception to the rule.

In the U.S., the 1981 Epidemiological Catchment Area (ECA) study, which employed the Diagnostic Interview Schedule (DIS) as an investigative tool, estimated the prevalence of major depression, as defined by the DSM-III, at 1.6% for men and 2.9% for women in the month prior to survey (Regier et al 1988). Utilizing the Composite International Diagnosis Interview modified by the University of Michigan (UM-CIDI), Blazer et al (1994) in the 1990–92 National Comorbidity Survey (NCS) instead found the past-month prevalence of major depression, as per DSM-III-R criteria, to be 3.8% for men and 5.9% for women.

Elsewhere in the world, summarizing the findings of a series of general population studies carried out in 10 countries with the DIS, the Cross-National Collaborative Group (Weissman et al 1996) noted annual rates of DSM-III major depression ranging from 0.8% in Taiwan to 5.8% in Christchurch, New Zealand.

Where the U.K. is concerned, the 1978–79 Camberwell Community Survey (Bebbington et al 1991) investigated depressive disorder, as defined by the ICD-9, using the PSE-CATEGO-ID. Here, the reported rate was 2.2% for men and 4.9% for women. A 1993 survey carried out in Great Britain by the Office of Population Censuses and Surveys (Meltzer et al 1995) queried 10,108 adults, instead, with the Clinical Interview Schedule–Revised (CIS-R) (Lewis et al 1992). Of these respondents, 14% scored 12 or higher on the CIS-R for the week prior to interview. The most common diagnosis, as per the World Health Organization International Classification of Diseases (World Health Organization 1993), was mixed anxiety and depressive disorder F41.2 at the rate of 7.7% (9.9% for women and 5.4% for men). Depressive disorder F32 was found in 2.1% of respondents (2.5% for women and 1.7% for men). In another study, Horwath et al (1992) estimated that 24.0% of the general population presented with depressive symptoms, and that these individuals ran four times the risk of developing dysthymia and five times that of suffering a first episode of major depression within a year.

The data reported in this article were collected in the course of an epidemiological survey conducted by telephone from June to October 1994, with the broader purpose of investigating sleep habits, sleep-related symptoms, and psychiatric and sleep disorders in a representative sample of the U.K. general population. Depression and associated risk factors were defined as per the DSM-IV.

Section snippets

Determination of the sample

The target population comprised noninstitutionalized residents 15 years of age or over (approximately 45,709,600 people). A representative sample was drawn using a stratified probabilistic approach based on the population distribution for the 11 areas of the U.K., as per 1991 census figures (Scotland, Wales, Northern Ireland, and the eight areas of England: North, Yorkshire and Humberside, East Midlands, West Midlands, East Anglia, South East, South West, and North West). The selection method

Overall

At time of interview, 25.5% (95% CI: 24.3–26.7%) of subjects responded positively to at least one of the three series of questions regarding depressive symptoms; however, only 250 subjects (weighted figure) or 5.0% (4.4–5.6%) of the sample received a depressive disorder diagnosis. This represents 20% of those who responded positively to one of the three series of screening questions.

Depressive symptoms

Regarding the first series of questions, 9.7% of the sample (or 35.3% of subjects with a depressive disorder)

Telephone interviews

A novel methodology was employed in this study, namely, telephone interviews performed with the help of an artificial intelligence tool (the expert system). This is an attractive alternative offering many advantages over face-to-face interviews. For one, telephone inquiries are estimated to be one fourth to one half as costly Davis et al 1993, Weeks et al 1983. In addition, subjects can be selected based on a broader sampling framework (Fenig et al 1993), and the time needed to complete the

Acknowledgements

This study was supported by the “Fond de la Recherche en Sante du Quebec” (FRSQ) and an educational grant from Synthelabo Group.

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Original ArticlesThe prevalence of depressive disorders in the united kingdom

Abstract

Introduction

Section snippets

Determination of the sample

Overall

Depressive symptoms

Telephone interviews

Acknowledgements

Diagnostic and Statistical Manual of Mental Disorders

Measuring depression in a communityA comparison of telephone and personal interviews

Public Opin Q

The Camberwell Community SurveyA summary of results

Soc Psychiatry Psychiatr Epidemiol

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

Am J Psychiatry

Epidemiology by computer

Soc Psychiatry Psychiatr Epidemiol

The changing rate of major depressionCross-national comparisons

JAMA

The New Zealand partner relations surveyMethodological results of a national telephone survey

AIDS

Factors affecting help-seeking during depression in a community sample

J Affect Disord

Telephone vs face-to-face interviewing in a community psychiatric survey

Am J Public Health

Characteristics of respondents and non-respondents in a telephone survey study of elderly consumers

Psychol Rep

Implications of the World Health Organization study of mental illness in general health care for training primary care staff

Br J Gen Pract

Mental Illness in the Community. The Pathway to Psychiatric Care

Surveys by TelephoneA National Comparison with Personal Interviews

Depressive symptoms as relative and attributable risk factors for first-onset major depression

Arch Gen Psychiatry

Applied Logistic Regression

Survey Sampling

Measuring psychiatric disorder in the communityA standardized assessment for use by lay interviewers

Psychol Med

Six-month prevalence of psychiatric disorders in three communities1980 to 1982

Arch Gen Psychiatry

Use of an expert system (Eval) in mental health epidemiological surveys

Validation of a knowledge based system (Adinfer) versus human experts

Original Articles
The prevalence of depressive disorders in the united kingdom