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One of the largest surveys ever conducted in the US studied the co-occurance of major depressive disorder (MDD) in specific population subgroups and the relationship of MDD to alcohol use disorders (AUDs). The National Epidemiologic Survey of Alcohol and Related Conditions (NESARC) did a face-to-face survey of more than 43,000 adults aged 18 years and older residing in households and group quarters in the United States. The new analysis of this 2001-2002 data shows for the first time that middle age and Native American race increase the likelihood of current or lifetime MDD, along with female gender, low income, and separation, divorce, or widowhood. Asian, Hispanic, and black race-ethnicity reduce that risk. The review appears in the current Archives of General Psychiatry and was conducted by the NIH's National Institute on Alcohol Abuse and Alcoholism (NIAAA).
The study's principal foci were alcohol dependence (alcoholism) and alcohol abuse and the psychiatric conditions that most frequently co-occur with those AUDs. Because of its size and scrutiny of multiple sociodemographic factors, the NESARC provides more precise information than previously available on between-group differences that influence risk For example, the analysis indicates that 5.28 percent of U.S. adults experienced MDD during the 12 months preceding the survey and 13.23 percent had experienced MDD at some time during their lives. The highest lifetime risk was among middle-aged adults, a shift from the younger adult population shown to be at highest risk by surveys conducted during the 1980s and 1990s. The authors note that "this marks an important transformation in the distribution of MDD in the general population and specific risk for baby-boomers aged 45 to 64 years."
Risk for the onset of MDD increases sharply between age 12 and age 16 and more gradually up to the early 40s when it begins to decline, with mean age of onset about age 30. Women are twice as likely as men to experience MDD and somewhat more likely to receive treatment. About 60 percent of persons with MDD received treatment specifically for the disorder, with mean treatment age at 33.5 years--a lag time of about 3 years between onset and treatment. Of all persons who experienced MDD, nearly one-half wanted to die, one-third considered suicide, and 8.8 percent reported a suicide attempt.
Among race-ethnic groups, Native Americans showed the highest (19.17 percent) lifetime MDD prevalence, followed by whites (14.58 percent), Hispanics (9.64 percent), Blacks (8.93 percent), and Asian or Pacific Islanders (8.77 percent). There has been little published information on diagnosed mental disorders among Native Americans, so this finding appears to warrant increased attention to the mental health needs of that group, the authors maintain.
 Among persons with current MDD, 14.1 percent also have an AUD, 4.6 percent have a drug use disorder, and 26 percent have nicotine dependence. More than 37 percent have a personality disorder and more than 36 percent have at least one anxiety disorder. Among persons with lifetime MDD, 40.3 percent had experienced an AUD, 17.2 percent had experienced a drug use disorder, and 30 percent had experienced nicotine dependence.
Major depression has traditionally been the most prevalent psychiatric disorder. This study has demonstrated that it is often accompanied by alcohol dependence which can provide both practitioners and researchers with new information to review and study the common biobehavioral factors that may underlie both conditions. The NESARC results demonstrate a strong relationship of MDD to substance dependence and a weak relationship to substance abuse, a finding that suggests focusing on dependence when studying the relationship of depression to substance use disorders.
Coexisting substance dependence disorder and MDD predict poor outcome among clinic patients. A decade ago, many treatment leaders discouraged treating MDD in patients with substance dependence on the grounds that arresting substance dependence was the more immediate need and that its resolution well might also resolve MDD. Results from foregoing epidemiologic surveys and several clinical trials over time altered that picture, so that treating both disorders simultaneously is today common practice.
The authors conclude by pointing out that "the variation in comorbidity by specific disorder highlights the importance of not collapsing disorders into broad categories and the need to better understand the variation. Given the seriousness of MDD, the importance of information on its prevalence, demographic correlates, and psychiatric comorbidity cannot be underestimated. This study provides such information and the grounds for further investigation in a number of areas."
Arch Gen Psychiatry. 2005;62:1069.
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