May 14, 2009

Major Depressive Episode and Treatment among Adults

Depression is a public health problem that affects millions of adults every year. It affects persons in all demographic groups, although some groups are more likely to experience depression than others. There are different treatment options for depression, including various psychotherapeutic approaches and medications. Moreover, treatment services are offered through a variety of sources, such as primary care physicians and psychiatrists. Gaining a better understanding of the rates of depression and the patterns of service use can help policymakers and administrators ensure that services are available to individuals who need them, that disparities in treatment can be addressed, and that effective services are offered through venues that people are most likely to use.

The National Survey on Drug Use and Health (NSDUH) includes questions about major depressive episode (MDE) and treatment for depression. MDE is defined using the diagnostic criteria in the 4th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), which specifies a period of 2 weeks or longer during which there is either depressed mood or loss of interest or pleasure and at least four other symptoms that reflect a change in functioning, including problems with sleep, eating, energy, concentration, and self-image. Treatment for depression is defined as seeing or talking to a medical doctor or other professional or using prescription medication in the past year for depression. This issue of The NSDUH Report examines MDE among adults aged 18 or older. All findings presented in this report are based on 2007 NSDUH data.

An estimated 16.5 million adults (7.5 percent) experienced at least one MDE in the past year (Table 1). The rate of past year MDE was lower among persons aged 50 or older (5.8 percent) than among those aged 18 to 25 or 26 to 49 (8.9 and 8.5 percent, respectively). Females were more likely than males to have experienced past year MDE (9.5 vs. 5.3 percent). Rates for past year MDE were higher among divorced or separated adults (13.1 percent) than among those in any other marital status category (5.3 percent among married adults, 7.9 percent among widowed persons, and 9.2 percent among adults who had never married).

The prevalence of MDE was related to overall perception of health. The rate of past year MDE was 14.2 percent among adults who reported that their overall health was fair or poor. In contrast, the rate of past year MDE was 4.3 percent among those who reported that their overall health was excellent.

Almost two thirds (64.5 percent) of adults who experienced past year MDE received treatment for depression in the past year (Table 1). Adults aged 50 or older who had MDE were more likely to have received treatment for depression than were those aged 18 to 25 or 26 to 49 (74.2 vs. 44.2 and 65.6 percent, respectively). Females with past year MDE were more likely than their male counterparts to have received treatment (68.0 vs. 57.8 percent). Adults who had not been married were less likely to have received treatment than those who were married or those who were divorced or separated (52.1 vs. 71.5 and 70.5 percent, respectively). Among adults with past year MDE, 78.4 percent of those who reported that their overall health was fair or poor received treatment for depression compared with 62.5 percent who said their health was good, 59.0 percent of those who said their health was very good, and 54.6 percent of those who said their health was excellent.

Among those who received treatment for depression in the past year, 68.8 percent saw or talked to a medical doctor or other health professional about depression and used prescription medication for depression (Figure 1). In addition, 24.0 percent saw or talked to a medical doctor or other health professional about depression, but did not use a prescription medication for depression. The remainder (7.1 percent) took prescription medication for depression, but did not see or talk with a medical doctor or other professional about depression.¹

Figure 1. Type of Treatment Received for Depression in the Past Year among Adults Who Experienced Past Year Major Depressive Episode (MDE) and Received Treatment for Depression in the Past Year*^,**: 2007

Among those adults who saw or talked to a medical doctor or other health professional about depression, over three fifths (61.9 percent) saw or talked to a general practitioner or family doctor (Figure 2). Also, 29.1 percent saw or talked to a psychiatrist or psychotherapist. A similar percentage (28.5 percent) saw or talked to a psychologist.

Figure 2. Type of Professional Seen among Adults with Past Year Major Depressive Episode (MDE) Who Saw or Talked to a Medical Doctor or Other Professional about Depression in the Past Year*^,**: 2007

About 1 in 13 Americans aged 18 or older experienced MDE in the past year, with particular subgroups—such as divorced or separated adults—having rates as high as 1 in 8. Despite the effectiveness of mental health treatment and a variety of available treatment options, one third of adults who experienced past year MDE did not receive treatment for depression in the past year. Rates of treatment use were particularly low among young adults aged 18 to 25, with less than half who had past year MDE receiving treatment for depression. Among adults who received treatment from a medical doctor or other health professional, over three fifths saw a general practitioner or family doctor. Because most adults with MDE consult or receive care from a family doctor, it is essential that general practitioners are kept up to date on the latest findings on screening and treatment for depression.