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Global variation in the prevalence and incidence of major depressive disorder: a systematic review of the epidemiological literature

  • A. J. Ferrari (a1) (a2), A. J. Somerville (a3), A. J. Baxter (a1) (a2), R. Norman (a1) (a4), S. B. Patten (a5), T. Vos (a1) and H. A. Whiteford (a1) (a2)...

Summarizing the epidemiology of major depressive disorder (MDD) at a global level is complicated by significant heterogeneity in the data. The aim of this study is to present a global summary of the prevalence and incidence of MDD, accounting for sources of bias, and dealing with heterogeneity. Findings are informing MDD burden quantification in the Global Burden of Disease (GBD) 2010 Study.


A systematic review of prevalence and incidence of MDD was undertaken. Electronic databases Medline, PsycINFO and EMBASE were searched. Community-representative studies adhering to suitable diagnostic nomenclature were included. A meta-regression was conducted to explore sources of heterogeneity in prevalence and guide the stratification of data in a meta-analysis.


The literature search identified 116 prevalence and four incidence studies. Prevalence period, sex, year of study, depression subtype, survey instrument, age and region were significant determinants of prevalence, explaining 57.7% of the variability between studies. The global point prevalence of MDD, adjusting for methodological differences, was 4.7% (4.4–5.0%). The pooled annual incidence was 3.0% (2.4–3.8%), clearly at odds with the pooled prevalence estimates and the previously reported average duration of 30 weeks for an episode of MDD.


Our findings provide a comprehensive and up-to-date profile of the prevalence of MDD globally. Region and study methodology influenced the prevalence of MDD. This needs to be considered in the GBD 2010 study and in investigations into the ecological determinants of MDD. Good-quality estimates from low-/middle-income countries were sparse. More accurate data on incidence are also required.

Corresponding author
*Address for correspondence: A. J. Ferrari, Policy and Evaluation Group, Queensland Centre for Mental Health Research, The Park Centre for Mental Health, Locked Bag 500, Sumner Park BC, Brisbane, QLD 4074, Australia. (Email:
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J Angst , A Gamma , M Gastpar , JP Lépine , J Mendlewicz , A Tylee (2002). Gender differences in depression. Epidemiological findings from the European DEPRES I and II studies. European Archives of Psychiatry and Clinical Neuroscience 252, 201209.

WL Baker , CM White , JC Cappelleri , J Kluger , CI Coleman (2009). Understanding heterogeneity in meta-analysis: the role of meta-regression. International Journal of Clinical Practice 63, 14261434.

P Brhlikova , AM Pollock , R Manners (2010). Global burden of disease estimates of depression – how reliable is the epidemiological evidence? Journal of the Royal Society of Medicine 104, 2535.

E Bromet , LH Andrade , I Hwang , NA Sampson , J Alonso , G de Girolamo , R de Graaf , K Demyttenaere , C Hu , N Iwata , AN Karam , J Kaur , S Kostyuchenko , JP Lepine , D Levinson , H Matschinger , ME Mora , MO Browne , J Posada-Villa , MC Viana , DR Williams , RC Kessler (2011). Cross-national epidemiology of DSM-IV major depressive episode. BMC Medicine 9, 90.

EJ Bromet , SF Gluzman , VI Paniotto , CPM Webb , NL Tintle , V Zakhozha , JM Havenaar , Z Gutkovich , S Kostyuchenko , JE Schwartz (2005). Epidemiology of psychiatric and alcohol disorders in Ukraine: findings from the Ukraine World Mental Health Survey. Social Psychiatry and Psychiatric Epidemiology 40, 681690.

SM Chang , BJ Hahm , JY Lee , MS Shin , HJ Jeon , JP Hong , HB Lee , DW Lee , MJ Cho (2008). Cross-national difference in the prevalence of depression caused by the diagnostic threshold. Journal of Affective Disorders 106, 159167.

PY Collins , V Patel , SS Joestl , D March , TR Insel , AS Daar , W Anderson , MA Dhansay , A Phillips , S Shurin , M Walport , W Ewart , SJ Savill , IA Bordin , EJ Costello , M Durkin , C Fairburn , RI Glass , W Hall , Y Huang , SE Hyman , K Jamison , S Kaaya , S Kapur , A Kleinman , A Ogunniyi , A Otero-Ojeda , MM Poo , V Ravindranath , BJ Sahakian , S Saxena , PA Singer , DJ Stein (2011). Grand challenges in global mental health. Nature 475, 2730.

FM Culbertson (1997). Depression and gender. An international review. American Psychologist 52, 2531.

R DerSimonian , R Kacker (2007). Random-effects model for meta-analysis of clinical trials: an update. Contemporary Clinical Trials 28, 105114.

R DerSimonian , N Laird (1986). Meta-analysis in clinical trials. Controlled Clinical Trials 7, 177188.

WW Eaton , M Kramer , JC Anthony , A Dryman , S Shapiro , BZ Locke (1989). The incidence of specific DIS/DSM-III mental disorders: data from the NIMH Epidemiologic Catchment Area Program. Acta Psychiatrica Scandinavica 79, 163178.

C Faravelli , BG Degl'Innocenti , L Aiazzi , G Incerpi , S Pallanti (1990). Epidemiology of mood disorders: a community survey in Florence. Journal of Affective Disorders 20, 135141.

JP Higgins , SG Thompson , JJ Deeks , DG Altman (2003). Measuring inconsistency in meta-analyses. BMJ 327, 557560.

AC Hollander , S Ekblad , D Mukhamadiev , R Muminova (2007). The validity of screening instruments for posttraumatic stress disorder, depression, and other anxiety symptoms in Tajikistan. Journal of Nervous Mental Disease 195, 955958.

M Hollifield , TD Warner , N Lian , B Krakow , JH Jenkins , J Kesler , J Stevenson , J Westermeyer (2002). Measuring trauma and health status in refugees: a critical review. Journal of the American Medical Association 288, 611621.

K Ihara , Y Muraoka , A Oiji , T Nadaoka (1998). Prevalence of mood disorders according to DSM-III-R criteria in the community elderly residents in Japan. Environmental Health and Preventive Medicine 3, 4449.

RC Kessler (1999). The World Health Organization International Consortium in Psychiatric Epidemiology (ICPE): initial work and future directions – the NAPE Lecture 1998. Nordic Association for Psychiatric Epidemiology. Acta Psychiatrica Scandinavica 99, 29.

ME Kruijshaar , J Barendregt , T Vos , R de Graaf , J Spijker , G Andrews (2005). Lifetime prevalence estimates of major depression: an indirect estimation method and a quantification of recall bias. European Journal of Epidemiology 20, 103111.

C Kuehner (2003). Gender differences in unipolar depression: an update of epidemiological findings and possible explanations. Acta Psychiatrica Scandinavica 108, 163174.

PM Lewinsohn , H Hops , RE Roberts , JR Seeley , JA Andrews (1993). Adolescent psychopathology: I. Prevalence and incidence of depression and other DSM-III-R disorders in high school students. Journal of Abnormal Psychology 102, 133144.

B Lopes Cardozo , OO Bilukha , CA Gotway , MI Wolfe , ML Gerber , M Anderson (2005). Mental health of women in postwar Afghanistan. Journal of Women's Health 14, 285293.

S Mogga , M Prince , A Alem , D Kebede , R Stewart , N Glozier , M Hotopf (2006). Outcome of major depression in Ethiopia: population-based study. British Journal of Psychiatry 189, 241246.

D Moher , A Liberati , J Tetzlaff , DG Altman , PRISMA Group (2009). Preferred reporting items for systematic reviews and meta-analyses: the PRISMA Statement. PLoS Med 6, e1000097.

CJL Murray , AD Lopez , R Black , CD Mathers , K Shibuya , M Ezzati , JA Salomon , CM Michaud , N Walker , T Vos (2007). Global Burden of Disease 2005: call for collaborators. Lancet 370, 109110.

ES Paykel , T Brugha , T Fryers (2005). Size and burden of depressive disorders in Europe. European Neuropsychopharmacology 15, 411423.

MR Phillips , J Zhang , Q Shi , Z Song , Z Ding , S Pang , X Li , Y Zhang , Z Wang (2009). Prevalence, treatment, and associated disability of mental disorders in four provinces in China during 2001–05: an epidemiological survey. Lancet 373, 20412053.

M Prince , V Patel , S Saxena , M Maj , J Maselko , MR Phillips , A Rahman (2007). No health without mental health. Lancet 370, 859877.

D Rodin , M Van Ommeren (2009). Commentary: Explaining enormous variations in rates of disorder in trauma-focused psychiatric epidemiology after major emergencies. International Journal of Epidemiology 38, 10451048.

S Saha , D Chant , J Welham , J McGrath (2005). A systematic review of the prevalence of schizophrenia. PLoS Medicine 2, e141.

JA Salomon (2010). New disability weights for the global burden of disease. Bulletin of the World Health Organization 88, 879.

S Seedat , KM Scott , MC Angermeyer , P Berglund , EJ Bromet , TS Brugha , K Demyttenaere , G de Girolamo , JM Haro , R Jin , EG Karam , V Kovess-Masfety , D Levinson , ME Medina Mora , Y Ono , J Ormel , BE Pennell , J Posada-Villa , NA Sampson , D Williams , RC Kessler (2009). Cross-national associations between gender and mental disorders in the World Health Organization World Mental Health Surveys. Archives of General Psychiatry 66, 785795.

GE Simon , DP Goldberg , M Von Korff , TB Üstün (2002). Understanding cross-national differences in depression prevalence. Psychological Medicine 32, 585594.

Z Steel , T Chey , D Silove , C Marnane , RA Bryant , M van Ommeren (2009). Association of torture and other potentially traumatic events with mental health outcomes among populations exposed to mass conflict and displacement: a systematic review and meta-analysis. JAMA 302, 537549.

TB Üstün , JL Ayuso-Mateos , S Chatterji , C Mathers , CJ Murray (2004). Global burden of depressive disorders in the year 2000. British Journal of Psychiatry 184, 386392.

HC Van Houwelingen , LR Arends , T Stijnen (2002). Advanced methods in meta-analysis: multivariate approach and meta-regression. Statistics in Medicine 21, 589624.

P Ventevogel , G De Vries , WF Scholte , NR Shinwari , H Faiz , R Nassery , W van den Brink , M Olff (2007). Properties of the Hopkins Symptom Checklist-25 (HSCL-25) and the Self-Reporting Questionnaire (SRQ-20) as screening instruments used in primary care in Afghanistan. Social Psychiatry and Psychiatric Epidemiology 42, 328335.

T Vos , MM Haby , JJ Barendregt , M Kruijshaar , J Corry , G Andrews (2004). The burden of major depression avoidable by longer-term treatment strategies. Archives of General Psychiatry 61, 10971103.

PS Wang , S Aguilar-Gaxiola , J Alonso , MC Angermeyer , G Borges , EJ Bromet , R Bruffaerts , G de Girolamo , R de Graaf , O Gureje , JM Haro , EG Karam , RC Kessler , V Kovess , MC Lane , S Lee , D Levinson , Y Ono , M Petukhova , J Posada-Villa , S Seedat , JE Wells (2007). Use of mental health services for anxiety, mood, and substance disorders in 17 countries in the WHO world mental health surveys. Lancet 370, 841850.

S Weich , R Araya (2004). International and regional variation in the prevalence of common mental disorders: do we need more surveys? British Journal of Psychiatry 184, 289290.

MM Weissman , RC Bland , GJ Canino , C Faravelli , S Greenwald , HG Hwu , PR Joyce , EG Karam , CK Lee , J Lellouch , JP Lepine , SC Newman , M Rubio-Stipec , JE Wells , PJ Wickramaratne , H Wittchen , EK Yeh (1996). Cross-national epidemiology of major depression and bipolar disorder. JAMA 276, 293299.

HU Wittchen (2000). Epidemiological research in mental disorders: lessons for the next decade of research – the NAPE Lecture 1999. Nordic Association for Psychiatric Epidemiology. Acta Psychiatrica Scandinavica 101, 210.

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