Kessler Ronald C, Berglund Patricia, Demler Olga, Jin Robert, Koretz Doreen, Merikangas Kathleen R, Rush A John, Walters Ellen E, Wang Philip S
Department of Health Care Policy, Harvard Medical School, Boston, MA 02115, USA.
JAMA. 2003 Jun 18;289(23):3095-105. doi: 10.1001/jama.289.23.3095.
Uncertainties exist about prevalence and correlates of major depressive disorder (MDD).
To present nationally representative data on prevalence and correlates of MDD by Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) criteria, and on study patterns and correlates of treatment and treatment adequacy from the recently completed National Comorbidity Survey Replication (NCS-R).
Face-to-face household survey conducted from February 2001 to December 2002.
The 48 contiguous United States.
Household residents ages 18 years or older (N = 9090) who responded to the NCS-R survey.
Prevalence and correlates of MDD using the World Health Organization's (WHO) Composite International Diagnostic Interview (CIDI), 12-month severity with the Quick Inventory of Depressive Symptomatology Self-Report (QIDS-SR), the Sheehan Disability Scale (SDS), and the WHO disability assessment scale (WHO-DAS). Clinical reinterviews used the Structured Clinical Interview for DSM-IV.
The prevalence of CIDI MDD for lifetime was 16.2% (95% confidence interval [CI], 15.1-17.3) (32.6-35.1 million US adults) and for 12-month was 6.6% (95% CI, 5.9-7.3) (13.1-14.2 million US adults). Virtually all CIDI 12-month cases were independently classified as clinically significant using the QIDS-SR, with 10.4% mild, 38.6% moderate, 38.0% severe, and 12.9% very severe. Mean episode duration was 16 weeks (95% CI, 15.1-17.3). Role impairment as measured by SDS was substantial as indicated by 59.3% of 12-month cases with severe or very severe role impairment. Most lifetime (72.1%) and 12-month (78.5%) cases had comorbid CIDI/DSM-IV disorders, with MDD only rarely primary. Although 51.6% (95% CI, 46.1-57.2) of 12-month cases received health care treatment for MDD, treatment was adequate in only 41.9% (95% CI, 35.9-47.9) of these cases, resulting in 21.7% (95% CI, 18.1-25.2) of 12-month MDD being adequately treated. Sociodemographic correlates of treatment were far less numerous than those of prevalence.
Major depressive disorder is a common disorder, widely distributed in the population, and usually associated with substantial symptom severity and role impairment. While the recent increase in treatment is encouraging, inadequate treatment is a serious concern. Emphasis on screening and expansion of treatment needs to be accompanied by a parallel emphasis on treatment quality improvement.
重度抑郁症（MDD）的患病率及其相关因素尚不确定。
根据《精神疾病诊断与统计手册》第四版（DSM-IV）标准，提供关于MDD患病率及其相关因素的全国代表性数据，以及来自最近完成的全国共病调查复制研究（NCS-R）的治疗模式、治疗相关性和治疗充分性的数据。
2001年2月至2002年12月进行的面对面家庭调查。
美国本土48个州。
对NCS-R调查做出回应的18岁及以上家庭居民（N = 9090）。
使用世界卫生组织（WHO）综合国际诊断访谈（CIDI）评估MDD的患病率及其相关因素，使用抑郁症状快速自评量表（QIDS-SR）评估12个月内的严重程度，使用希恩残疾量表（SDS）和WHO残疾评估量表（WHO-DAS）进行评估。临床再次访谈使用DSM-IV结构化临床访谈。
CIDI标准下MDD的终生患病率为16.2%（95%置信区间[CI]，15.1 - 17.3）（3260万 - 3510万美国成年人），12个月患病率为6.6%（95% CI，5.9 - 7.3）（1310万 - 1420万美国成年人）。几乎所有CIDI标准下12个月内的病例使用QIDS-SR独立分类为具有临床意义，其中轻度占10.4%，中度占38.6%，重度占38.0%，极重度占12.9%。平均发作持续时间为16周（95% CI，15.1 - 17.3）。SDS测量的角色损害很严重，12个月内病例中有59.3%存在严重或极严重的角色损害。大多数终生病例（72.1%）和12个月病例（78.5%）患有共病的CIDI/DSM-IV疾病，MDD很少作为原发性疾病。虽然12个月内病例中有51.6%（95% CI，46.1 - 57.2）因MDD接受了医疗保健治疗，但其中只有41.9%（95% CI，35.9 - 47.9）的治疗是充分的，导致12个月内MDD病例中只有21.7%（95% CI，18.1 - 25.2）得到了充分治疗。治疗的社会人口学相关因素远少于患病率的相关因素。
重度抑郁症是一种常见疾病，在人群中广泛分布，通常伴有严重的症状和角色损害。虽然近期治疗的增加令人鼓舞，但治疗不足是一个严重问题。在强调筛查和扩大治疗的同时，需要同样重视提高治疗质量。
