Unit 26 Mental Health, Department of Epidemiology and Health Monitoring, Robert Koch-Institute, Berlin, Germany.
Psychologische Hochschule Berlin, Berlin, Germany.
BMC Psychiatry. 2018 Dec 20;18(1):394. doi: 10.1186/s12888-018-1973-7.
Although an "epidemic" of depression is frequently claimed, empirical evidence is inconsistent, depending on country, study design and depression assessment. Little is known about changes in depression over time in Germany, although health insurance companies report frequency increases. Here we examined time trends in depression prevalence, severity and health-related correlates in the general population.
Data were obtained from the mental health module of the "German Health Interview and Examination Survey for Adults" (2009-2012, n = 3265) and the mental health supplement of the "German National Health Interview and Examination Survey 1998" (1997-1999, n = 4176), excluding respondents older than 65. 12-month major depressive disorder (MDD), severity and symptoms were assessed based on the WHO Composite International Diagnostic Interview. Health-related quality of life (SF-36), self-reported sick days or days with limitations in normal daily life activities were examined, too. Calculations were carried out population-weighted. Additional age-standardized analyses were conducted to account for demographic changes.
Overall, MDD 12-month prevalence remained stable at 7.4%. Women showed a shifted age distribution with increased prevalence at younger ages, and increasing MDD severity. Time trends in health-related correlates occurred both in participants with and without MDD. Mental health disability increased over time, particularly among men with MDD, reflected by the mental component score of the SF-36 and days with activity limitation due to mental health problems. Demographic changes had a marginal impact on the time trends.
In contrast to the ongoing international debate regarding increased depression rates in western countries, we found no increase in overall MDD prevalence in Germany over a long period. In conclusion, increased depression frequencies in national health insurance data and growing health care costs associated with depression are not attributable to overall prevalence changes at a population level. However, shifted age distribution and increased severity among women may reflect a rising depression risk within this specific subgroup, and changes in health-related correlates indicate a growing mental health care need for depression, particularly among men.
尽管经常有人声称抑郁症是一种“流行病”，但实证证据却因国家、研究设计和抑郁评估的不同而不一致。尽管医疗保险公司报告发病率有所增加，但人们对德国抑郁症随时间变化的情况知之甚少。在这里，我们研究了一般人群中抑郁症患病率、严重程度和与健康相关的相关因素的时间趋势。
数据来自“德国成人健康访谈和检查调查”的心理健康模块（2009-2012 年，n=3265）和“德国国家健康访谈和检查调查 1998 年”的心理健康补充调查（1997-1999 年，n=4176），不包括年龄大于 65 岁的受访者。根据世界卫生组织综合国际诊断访谈，评估了 12 个月的重度抑郁症（MDD）、严重程度和症状。还检查了与健康相关的生活质量（SF-36）、自我报告的病假或正常日常生活活动受限天数。计算是在人口加权的基础上进行的。进行了额外的年龄标准化分析，以考虑人口统计变化。
总体而言，MDD 的 12 个月患病率保持稳定，为 7.4%。女性的年龄分布发生了转移，年轻年龄的患病率增加，MDD 的严重程度也增加。参与者无论是否患有 MDD，与健康相关的相关因素的时间趋势都发生了变化。心理健康障碍随着时间的推移而增加，尤其是患有 MDD 的男性，反映在 SF-36 的心理成分评分和由于心理健康问题导致的活动受限天数上。人口统计变化对时间趋势的影响很小。
与西方国家关于抑郁症发病率增加的国际持续辩论相反，我们发现德国在很长一段时间内 MDD 的总体患病率没有增加。总之，国家健康保险数据中抑郁症频率的增加和与抑郁症相关的不断增长的医疗保健费用不能归因于人口水平的总体患病率变化。然而，女性的年龄分布转移和严重程度增加可能反映了特定亚组中抑郁症风险的上升，与健康相关的相关因素的变化表明，抑郁症的心理健康护理需求不断增加，尤其是在男性中。
