Age differences in the prevalence and co-morbidity of DSM-IV major depressive episodes: results from the WHO World Mental Health Survey Initiative
Corresponding Author
Ronald C. Kessler Ph.D.
Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts
Department of Health Care Policy, Harvard Medical School, 180 Longwood Avenue, Boston, MA 02115Search for more papers by this authorVictoria Shahly Ph.D.
Boston Psychoanalytic Society and Institute, Boston, Massachusetts
Search for more papers by this authorEvelyn Bromet Ph.D.
Department of Psychiatry, State University of New York at Stony Brook, New York, New York
Search for more papers by this authorIrving Hwang M.A.
Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts
Search for more papers by this authorKatie A. McLaughlin Ph.D.
Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts
Search for more papers by this authorNancy Sampson B.A.
Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts
Search for more papers by this authorLaura Helena Andrade M.D. Ph.D.
Section of Psychiatric Epidemiology-LIM 23, Department and Institute of Psychiatry, School of Medicine, University of São Paulo, São Paulo, Brazil
Search for more papers by this authorGiovanni de Girolamo M.D.
IRCCS Centro S. Giovanni di Dio Fatebenefratelli, Brescia, Italy
Search for more papers by this authorKoen Demyttenaere M.D. Ph.D.
Department of Psychiatry, University Hospital Gasthuisberg, Leuven, Belgium
Search for more papers by this authorJosep Maria Haro M.D. M.P.H. Ph.D.
Sant Joan de Deu-SSM, Barcelona; Ciber en Salud Mental (CIBERSAM), ISCIII Barcelona, Barcelona, Spain
Search for more papers by this authorAimee N. Karam Ph.D.
Department of Psychiatry and Clinical Psychology, Saint George Hospital University Medical Center, Beirut, Lebanon
Department of Psychiatry and Clinical Psychology, Faculty of Medicine, Balamand University Medical School, Beirut, Lebanon
Institute for Development, Research, Advocacy and Applied Care (IDRAAC), Beirut, Lebanon
Search for more papers by this authorStanislav Kostyuchenko M.D.
Ukrainian Psychiatric Association, Kiev, Ukraine
Search for more papers by this authorViviane Kovess M.D. Ph.D.
EA 4069 Université Paris Descartes, Paris, France
Search for more papers by this authorCarmen Lara M.D. Ph.D.
Autonomous University of Puebla, Puebla, Mexico
Search for more papers by this authorDaphna Levinson Ph.D.
Research & Planning, Mental Health Services Ministry of Health, Jerusalem, Israel
Search for more papers by this authorHerbert Matschinger Ph.D.
Clinic of Psychiatry, University of Leipzig, Leipzig, Germany
Search for more papers by this authorYoshibumi Nakane M.D. Ph.D.
Nagasaki University, Nagasaki, Japan
Search for more papers by this authorMark Oakley Browne Ph.D. FRANZCP
Discipline of Psychiatry, University of Tasmania and Tasmanian Government Department of Health and Human Services, Tasmania, Australia
Search for more papers by this authorJohan Ormel Ph.D.
Department of Psychiatry and Department of Epidemiology and Bioinformatics, University Medical Center Groningen, Groningen, The Netherlands
Graduate School of Behavioural and Cognitive Neurosciences and Graduate School for Experimental Psychopathology, University of Groningen, Groningen, The Netherlands
Search for more papers by this authorJose Posada-Villa M.D.
Ministry of Social Protection, Colegio Mayor de Cundinamarca University, Bogota, Colombia
Search for more papers by this authorRajesh Sagar M.D.
Department of Psychiatry, All India Institute of Medical Sciences, Delhi, India
Search for more papers by this authorDan J. Stein M.D. Ph.D.
Department of Psychiatry, University of Cape Town, Cape Town, South Africa
Search for more papers by this authorCorresponding Author
Ronald C. Kessler Ph.D.
Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts
Department of Health Care Policy, Harvard Medical School, 180 Longwood Avenue, Boston, MA 02115Search for more papers by this authorVictoria Shahly Ph.D.
Boston Psychoanalytic Society and Institute, Boston, Massachusetts
Search for more papers by this authorEvelyn Bromet Ph.D.
Department of Psychiatry, State University of New York at Stony Brook, New York, New York
Search for more papers by this authorIrving Hwang M.A.
Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts
Search for more papers by this authorKatie A. McLaughlin Ph.D.
Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts
Search for more papers by this authorNancy Sampson B.A.
Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts
Search for more papers by this authorLaura Helena Andrade M.D. Ph.D.
Section of Psychiatric Epidemiology-LIM 23, Department and Institute of Psychiatry, School of Medicine, University of São Paulo, São Paulo, Brazil
Search for more papers by this authorGiovanni de Girolamo M.D.
IRCCS Centro S. Giovanni di Dio Fatebenefratelli, Brescia, Italy
Search for more papers by this authorKoen Demyttenaere M.D. Ph.D.
Department of Psychiatry, University Hospital Gasthuisberg, Leuven, Belgium
Search for more papers by this authorJosep Maria Haro M.D. M.P.H. Ph.D.
Sant Joan de Deu-SSM, Barcelona; Ciber en Salud Mental (CIBERSAM), ISCIII Barcelona, Barcelona, Spain
Search for more papers by this authorAimee N. Karam Ph.D.
Department of Psychiatry and Clinical Psychology, Saint George Hospital University Medical Center, Beirut, Lebanon
Department of Psychiatry and Clinical Psychology, Faculty of Medicine, Balamand University Medical School, Beirut, Lebanon
Institute for Development, Research, Advocacy and Applied Care (IDRAAC), Beirut, Lebanon
Search for more papers by this authorStanislav Kostyuchenko M.D.
Ukrainian Psychiatric Association, Kiev, Ukraine
Search for more papers by this authorViviane Kovess M.D. Ph.D.
EA 4069 Université Paris Descartes, Paris, France
Search for more papers by this authorCarmen Lara M.D. Ph.D.
Autonomous University of Puebla, Puebla, Mexico
Search for more papers by this authorDaphna Levinson Ph.D.
Research & Planning, Mental Health Services Ministry of Health, Jerusalem, Israel
Search for more papers by this authorHerbert Matschinger Ph.D.
Clinic of Psychiatry, University of Leipzig, Leipzig, Germany
Search for more papers by this authorYoshibumi Nakane M.D. Ph.D.
Nagasaki University, Nagasaki, Japan
Search for more papers by this authorMark Oakley Browne Ph.D. FRANZCP
Discipline of Psychiatry, University of Tasmania and Tasmanian Government Department of Health and Human Services, Tasmania, Australia
Search for more papers by this authorJohan Ormel Ph.D.
Department of Psychiatry and Department of Epidemiology and Bioinformatics, University Medical Center Groningen, Groningen, The Netherlands
Graduate School of Behavioural and Cognitive Neurosciences and Graduate School for Experimental Psychopathology, University of Groningen, Groningen, The Netherlands
Search for more papers by this authorJose Posada-Villa M.D.
Ministry of Social Protection, Colegio Mayor de Cundinamarca University, Bogota, Colombia
Search for more papers by this authorRajesh Sagar M.D.
Department of Psychiatry, All India Institute of Medical Sciences, Delhi, India
Search for more papers by this authorDan J. Stein M.D. Ph.D.
Department of Psychiatry, University of Cape Town, Cape Town, South Africa
Search for more papers by this authorAbstract
Background: Although depression appears to decrease in late life, this could be due to misattribution of depressive symptoms to physical disorders that increase in late life. Methods: We investigated this issue by studying age differences in co-morbidity of DSM-IV major depressive episodes (MDE) with chronic physical conditions in the WHO World Mental Health (WMH) surveys, a series of community epidemiological surveys of respondents in 10 developed countries (n=52,485) and 8 developing countries (n=37,265). MDE and other mental disorders were assessed with the Composite International Diagnostic Interview (CIDI). Organic exclusion rules were not used to avoid inappropriate exclusion of cases with physical co-morbidity. Physical conditions were assessed with a standard chronic conditions checklist. Results: Twelve-month DSM-IV/CIDI MDE was significantly less prevalent among respondents ages 65+ than younger respondents in developed but not developing countries. Prevalence of co-morbid mental disorders generally either decreased or remained stable with age, while co-morbidity of MDE with mental disorders generally increased with age. Prevalence of physical conditions, in comparison, generally increased with age, while co-morbidity of MDE with physical conditions generally decreased with age. Depression treatment was lowest among the elderly in developed and developing countries. Conclusions: The weakening associations between MDE and physical conditions with increasing age argue against the suggestion that the low estimated prevalence of MDE among the elderly is due to increased confounding with physical disorders. Future study is needed to investigate processes that might lead to a decreasing impact of physical illness on depression among the elderly. Depression and Anxiety, 2010. © 2009 Wiley-Liss, Inc.
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