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Low prevalence of major depressive disorder in Taiwanese adults: possible explanations and implications

  • S.-C. Liao (a1) (a2), W. J. Chen (a1) (a2), M.-B. Lee (a2), F.-W. Lung (a3) (a4), T.-J. Lai (a5), C.-Y. Liu (a6), C.-Y. Lin (a7), M.-J. Yang (a8) and C.-C. Chen (a3)...



This study examined the prevalence of major depressive disorder (MDD), and the correlations and co-morbid conditions associated with MDD, in the adult Taiwanese population, which a previous estimate in the 1980s had found to be at the lower end of the spectrum worldwide. Possible explanations for the reported low prevalence of MDD were evaluated.


As part of a survey of common psychiatric disorders in a nationally representative sample of individuals aged ⩾18 years who were non-institutionalized civilians in Taiwan, a face-to-face interview using the paper version of the World Mental Health Survey of the World Health Organization (WHO) Composite International Diagnostic Interview (WMH-CIDI) was conducted between 2003 and 2005. Functional impairment and help-seeking behaviors were compared between Taiwanese subjects with MDD and their counterparts in the USA.


Among the 10 135 respondents, the lifetime prevalence of MDD was 1.20% [standard error (s.e.)=0.2%]. Individuals who were divorced or widowed, aged ⩽40 years, and female were at increased risk, whereas rural residents were at lower risk for MDD. The proportion of MDD cases co-morbid with other psychiatric disorders in this study was much lower than in the US study. Only one-third of Taiwanese individuals with MDD sought help despite having twice the number of lost workdays compared with the US sample.


Despite the low prevalence of MDD in Taiwanese adults, the pattern of low help-seeking behavior and profound functional impairment indicates much room for improvement in the early detection of and intervention in major depression in this population.


Corresponding author

*Address for correspondence: W. J. Chen, M.D., Sc.D., Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, 17 Xu-Zhou Road, Taipei 100, Taiwan. (Email: [W. J. Chen]
(Email: [M.-B. Lee]


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Andrade, L, Caraveo-Anduaga, JJ, Berglund, P, Bijl, RV, De Graaf, R, Vollebergh, W, Dragomirecka, E, Kohn, R, Keller, M, Kessler, RC, Kawakami, N, Kilic, C, Offord, D, Ustun, TB, Wittchen, HU (2003). The epidemiology of major depressive episodes: results from the International Consortium of Psychiatric Epidemiology (ICPE) Surveys. International Journal of Methods in Psychiatric Research 12, 3–21.
Chang, SM, Hahm, B-J, Lee, J-Y, Shin, MS, Jeon, HJ, Hong, J-P, Lee, HB, Lee, D-W, Cho, MJ (2008). Cross-national difference in the prevalence of depression caused by the diagnostic threshold. Journal of Affective Disorders 106, 159167.
Chien, IC, Chou, Y-J, Lin, C-H, Bih, S-H, Chou, P (2004). Prevalence of psychiatric disorders among National Health Insurance enrollees in Taiwan. Psychiatric Services 55, 691697.
Compton, WM, Helzer, JE, Hwu, HG, Yeh, EK, McEvoy, L, Tipp, JE, Spitznagel, EL (1991). New methods in cross-cultural psychiatry: psychiatric illness in Taiwan and the United States. American Journal of Psychiatry 148, 16971704.
Demyttenaere, K, Bruffaerts, R, Posada-Villa, J, Gasquet, I, Kovess, V, Lepine, JP, Angermeyer, MC, Bernert, S, de Girolamo, G, Morosini, P, Polidori, G, Kikkawa, T, Kawakami, N, Ono, Y, Takeshima, T, Uda, H, Karam, EG, Fayyad, JA, Karam, AN, Mneimneh, ZN, Medina-Mora, ME, Borges, G, Lara, C, de Graaf, R, Ormel, J, Gureje, O, Shen, Y, Huang, Y, Zhang, M, Alonso, J, Haro, JM, Vilagut, G, Bromet, EJ, Gluzman, S, Webb, C, Kessler, RC, Merikangas, KR, Anthony, JC, Von Korff, MR, Wang, PS, Brugha, TS, Aguilar-Gaxiola, S, Lee, S, Heeringa, S, Pennell, BE, Zaslavsky, AM, Ustun, TB, Chatterji, S, WHO World Mental Health Survey Consortium (2004). Prevalence, severity, and unmet need for treatment of mental disorders in the World Health Organization World Mental Health Surveys. Journal of the American Medical Association 291, 25812590.
Fava, M, Rankin, MA, Wright, EC, Alpert, JE, Nierenberg, AA, Pava, J, Rosenbaum, JF (2000). Anxiety disorders in major depression. Comprehensive Psychiatry 41, 97–102.
Hwu, HG, Chang, IH, Yeh, EK, Chang, CJ, Yeh, LL (1996). Major depressive disorder in Taiwan defined by the Chinese Diagnostic Interview Schedule. Journal of Nervous and Mental Disease 184, 497502.
Hwu, HG, Yeh, EK, Chang, LY (1989). Prevalence of psychiatric disorders in Taiwan defined by the Chinese Diagnostic Interview Schedule. Acta Psychiatrica Scandinavica 79, 136147.
Janal, MN (1996). Pain sensitivity, exercise and stoicism. Journal of the Royal Society of Medicine 89, 376381.
Kessler, RC, Abelson, J, Demler, O, Escobar, JI, Gibbon, M, Guyer, ME, Howes, MJ, Jin, R, Vega, WA, Walters, EE, Wang, P, Zaslavsky, A, Zheng, H (2004). Clinical calibration of DSM-IV diagnoses in the World Mental Health (WMH) version of the World Health Organization (WHO) Composite International Diagnostic Interview (WMHCIDI). International Journal of Methods in Psychiatric Research 13, 122139.
Kessler, RC, Berglund, P, Demler, O, Jin, R, Koretz, D, Merikangas, KR, Rush, AJ, Walters, EE, Wang, PS (2003). The epidemiology of major depressive disorder: results from the National Comorbidity Survey Replication (NCS-R). Journal of the American Medical Association 289, 30953105.
Kessler, RC, Little, RJA, Groves, RM (1995). Advances in strategies for minimizing and adjusting for survey nonresponse. Epidemiologic Reviews 17, 192204.
Kessler, RC, McGonagle, KA, Zhao, S, Nelson, CB, Hughes, M, Eshleman, S, Wittchen, H-U, Kendler, KS (1994). Lifetime and 12-month prevalence of DSM-III-R psychiatric disorders in the United States: results from the National Comorbidity Survey. Archives of General Psychiatry 51, 8–19.
Kessler, RC, Ustun, TB (2004). The World Mental Health (WMH) Survey Initiative version of the World Health Organization (WHO) Composite International Diagnostic Interview (CIDI). International Journal of Methods in Psychiatric Research 13, 93–121.
Kessler, RC, Zhao, S, Katz, SJ, Kouzis, AC, Frank, RG, Edlund, M, Leaf, P (1999). Past-year use of outpatient services for psychiatric problems in the National Comorbidity Survey. American Journal of Psychiatry 156, 115123.
Kish, L (1949). A procedure for objective respondent selection within the household. Journal of the American Statistical Association 44, 380387.
Lee, S, Tsang, A, Huang, YQ, He, YL, Liu, ZR, Zhang, MY, Shen, YC, Kessler, RC (2009). The epidemiology of depression in metropolitan China. Psychological Medicine 39, 735747.
Lee, S, Tsang, A, Zhang, MY, Huang, YQ, He, YL, Liu, ZR, Shen, YC, Kessler, RC (2007). Lifetime prevalence and inter-cohort variation in DSM-IV disorders in metropolitan China. Psychological Medicine 37, 6171.
Liu, CY, Hung, YT, Chuang, YL, Chen, YJ, Weng, WS, Liu, JS, Liang, KY (2006). Incorporating development stratification of Taiwan townships into sampling design of large scale health interview survey [in Chinese, with English abstract]. Journal of Health Management 4, 122.
Liu, PKC, Tung, A-C (2003). Urban development in Taiwan: retrospect and prospect [in Chinese, with English abstract]. Journal of Population Studies 26, 125.
Mojtabai, R, Olfson, M, Sampson, NA, Jin, R, Druss, B, Wang, PS, Wells, KB, Pincus, HA, Kessler, RC (2011). Barriers to mental health treatment: results from the National Comorbidity Survey Replication. Psychological Medicine 41, 17511761.
Naganuma, Y, Tachimori, H, Kawakami, N, Takeshima, T, Ono, Y, Uda, H, Hata, Y, Nakane, Y, Nakane, H, Iwata, N, Furukawa, TA, Kikkawa, T (2006). Twelve-month use of mental health services in four areas in Japan: findings from the World Mental Health Japan Survey 2002–2003. Psychiatry and Clinical Neurosciences 60, 240248.
Narrow, WE, Rae, DS, Robins, LN, Regier, DA (2002). Revised prevalence estimates of mental disorders in the United States: using a clinical significance criterion to reconcile 2 surveys' estimates. Archives of General Psychiatry 59, 115123.
Nock, MK, Hwang, I, Sampson, N, Kessler, RC, Angermeyer, M, Beautrais, A, Borges, G, Bromet, E, Bruffaerts, R, de Girolamo, G, de Graaf, R, Florescu, S, Gureje, O, Haro, JM, Hu, C, Huang, Y, Karam, EG, Kawakami, N, Kovess, V, Levinson, D, Posada-Villa, J, Sagar, R, Tomov, T, Viana, MC, Williams, DR (2009). Cross-national analysis of the associations among mental disorders and suicidal behavior: findings from the WHO World Mental Health Surveys. PLoS Medicine 6, e1000123.
Regier, DA, Kaelber, CT, Rae, DS, Farmer, ME, Knauper, B, Kessler, RC, Norquist, GS (1998). Limitations of diagnostic criteria and assessment instruments for mental disorders: implications for research and policy. Archives of General Psychiatry 55, 109115.
Regier, DA, Narrow, WE, Rae, DS, Manderscheid, RW, Locke, BZ, Goodwin, FK (1993). The de facto US mental and addictive disorders service system: Epidemiologic Catchment Area prospective 1-year prevalence rates of disorders and services. Archives of General Psychiatry 50, 8594.
Rush, AJ, Trivedi, MH, Ibrahim, HM, Carmody, TJ, Arnow, B, Klein, DN, Markowitz, JC, Ninan, PT, Kornstein, S, Manber, R, Thase, ME, Kocsis, JH, Keller, MB (2003). The 16-item Quick Inventory of Depressive Symptomatology (QIDS), clinician rating (QIDS-C), and self-report (QIDS-SR): a psychometric evaluation in patients with chronic major depression. Biological Psychiatry 54, 573583.
Spain, D (1984). Taiwan: country profile. International Demographics 3, 48.
Tseng, MM, Fang, D, Lee, MB, Chie, WC, Liu, JP, Chen, WJ (2007). Two-phase survey of eating disorders in gifted dance and non-dance high-school students in Taiwan. Psychological Medicine 37, 10851096.
Weich, S (2005). Absence of spatial variation in rates of the common mental disorders. Journal of Epidemiology and Community Health 59, 254257.
Weissman, MM, Bland, RC, Canino, GJ, Faravelli, C, Greenwald, S, Hwu, HG, Joyce, PR, Karam, EG, Lee, CK, Lellouch, J, Lepine, JP, Newman, SC, Rubio-Stipec, M, Wells, JE, Wickramaratne, PJ, Wittchen, H, Yeh, EK (1996). Cross-national epidemiology of major depression and bipolar disorder. Journal of the American Medical Association 276, 293299.
Wen, CP, Levy, DT, Cheng, TY, Hsu, CC, Tsai, SP (2005). Smoking behaviour in Taiwan, 2001. Tobacco Control 14, i51i55.
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Psychological Medicine
  • ISSN: 0033-2917
  • EISSN: 1469-8978
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