Hostname: page-component-848d4c4894-wzw2p Total loading time: 0 Render date: 2024-06-13T07:44:40.264Z Has data issue: false hasContentIssue false

Comorbidity of DSM–III–R Major Depressive Disorder in the General Population: Results from the US National Comorbidity Survey

Published online by Cambridge University Press:  06 August 2018

R. C. Kessler*
Affiliation:
Institute for Social Research, University of Michigan, Ann Arbor, Michigan, US
C. B. Nelson
Affiliation:
Institute for Social Research, University of Michigan, Ann Arbor, Michigan, US
K. A. McGonagle
Affiliation:
Institute for Social Research, University of Michigan, Ann Arbor, Michigan, US
J. Liu
Affiliation:
Institute for Social Research, University of Michigan, Ann Arbor, Michigan, US
M. Swartz
Affiliation:
Department of Psychiatry, Duke University Medical Center, Durham, North Carolina, US
D. G. Blazer
Affiliation:
Department of Psychiatry, Duke University Medical Center, Durham, North Carolina, US
*
Dr R. C. Kessler, Institute for Social Research, Box 1248, University of Michigan, Ann Arbor, MI 48106-1248, US

Abstract

General population data are presented on the prevalence and correlates of comorbidity between DSM–III–R major depressive disorder (MDD) and other DSM–III–R disorders. The data come from the US National Comorbidity Survey, a large general population survey of persons aged 15–54 years in the non-institutionalised civilian population. Diagnoses are based on a modified version of the Composite International Diagnostic Interview (CIDI). The analysis shows that most cases of lifetime MDD are secondary, in the sense that they occur in people with a prior history of another DSM–III–R disorder. Anxiety disorders are the most common primary disorders. The time-lagged effects of most primary disorders on the risk of subsequent MDD continue for many years without change in magnitude. Secondary MDD is, in general, more persistent and severe than pure or primary MDD. This has special public health significance because lifetime prevalence of secondary MDD has increased in recent cohorts, while the prevalence of pure and primary depression has remained unchanged.

Type
Research Article
Copyright
Copyright © 1996 The Royal College of Psychiatrists 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Akiskal, H. S. (1985) Anxiety: definition, relationship to depression, and proposal for an integrative model. In Anxiety and the Anxiety Disorders (eds Tuma, A. H. & Maser, J. D.), pp. 787797. Hillsdale, NJ: Lawrence Erlbaum Associates.Google Scholar
Akiskal, H. S. (1990) Toward a clinical understanding of the relationship of anxiety and depressive disorders. In Comorbidity of Mood and Anxiety Disorders (eds Maser, J. D. & Cloninger, C. R.), pp. 597607. Washington, DC: APP.Google Scholar
American Psychiatric Association (1980) Diagnostic and Statistical Manual of Mental Disorders (3rd edn) (DSM–III). Washington, DC: APA.Google Scholar
American Psychiatric Association (1987) Diagnostic and Statistical Manual of Mental Disorders (3rd edn, revised) (DSM–III–R). Washington, DC: APA.Google Scholar
American Psychiatric Association (1994) Diagnostic and Statistical Manual of Mental Disorders (4th edn) (DSM–IV). Washington, DC: APA.Google Scholar
Angst, J. (1996) Comorbidity of mood disorders: A longitudinal prospective study. British Journal of Psychiatry, this issue.CrossRefGoogle Scholar
Angst, J. & Dobler-Mikola, A. (1984a) Do the diagnostic criteria determine the sex ratio in depression? Journal of Affective Disorders, 7, 189198.CrossRefGoogle ScholarPubMed
Angst, J. & Dobler-Mikola, A. (1984b) The definition of depression. Psychiatry Research, 18, 401406.Google Scholar
Angst, J., Vollrath, M., Merikangas, K. R., et al (1990) Comorbidity of anxiety and depression in the Zurich Cohort Study of young adults. In Comorbidity of Mood and Anxiety Disorders (eds Maser, J. D. & Cloninger, C. R.), pp. 123137. Washington, DC: APP.Google Scholar
Blazer, D. G., Kessler, R. C., McGonagle, K. A., et al (1994) The prevalence and distribution of major depression in a national community sample: the National Comorbidity Survey. American Journal of Psychiatry, 151, 979986.Google Scholar
Boyd, J. H., Burke, J. D., Gruenberg, E., et al (1984) Exclusion criteria of DSM–III: A study of co-occurrence of hierarchy-free syndromes. Archives of General Psychiatry, 41, 983989.CrossRefGoogle ScholarPubMed
Bromet, E. J., Dunn, L. O., Connell, M. M., et al (1986) Long-term reliability of diagnosing lifetime major depression in a community sample. Archives of General Psychiatry, 43, 435440.Google Scholar
Bronisch, T. & Hecht, H. (1990) Major depression with and without a coexisting anxiety disorder: social dysfunction, social integration, and personality features. Journal of Affective Disorders, 20, 151157.CrossRefGoogle ScholarPubMed
Cloninger, C. R. (1989) Establishment of diagnostic validity in psychiatric illness: Robins & Guze's method revised. In Validity of Psychiatric Diagnosis (eds Robins, L. N. & Barrett, J.), pp. 918. New York: Raven Press.Google Scholar
Cloninger, C. R., Martin, R. L., Guze, S. B., et al (1981) A blind follow-up and family study of anxiety neuroses: preliminary analysis of St. Louis 500. In Anxiety: New Research and Changing Concepts (eds Klein, D. F. & Rabkin, J.), pp. 137150. New York: Raven.Google Scholar
Cloninger, C. R., Martin, R. L., Guze, S. B., et al (1990) The empirical structure of psychiatric comorbidity and its theoretical significance. In Comorbidity of Mood and Anxiety Disorders (eds Maser, J. D. & Cloninger, C. R.), pp. 439462. Washington, DC: APP.Google Scholar
Cooke, D. J. (1981) Life events and syndrome of depression in the general population. Social Psychiatry, 16, 181186.CrossRefGoogle Scholar
Coryell, W., Endicott, J., Andreasen, N. C., et al (1988) Depression and panic attacks: the significance of overlap as reflected in follow-up and family study data. American Journal of Psychiatry, 145, 293300.Google Scholar
Cottler, L. B., Robins, L. N. & Helzer, J. E. (1989) The reliability of the CIDI-SAM: a comprehensive substance abuse interview. British Journal of Addiction, 84, 802814.Google Scholar
Cottler, L. B., Robins, L. N., Grant, B., et al (1991) The CIDI-CORE substance abuse and dependence questions. Cross-cultural and nosological issues. British Journal of Psychiatry, 159, 653658.CrossRefGoogle ScholarPubMed
Cross-National Collaborative Group (1992) The changing rate of major depression. Journal of the American Medical Association, 268, 30983105.CrossRefGoogle Scholar
Dohrenwend, B. P. (1990) Notes on some epidemiologic studies of comorbidity. In Comorbidity of Mood and Anxiety Disorders (eds Maser, J. D. & Cloninger, C. R.), pp. 177185. Washington, DC: APP.Google Scholar
Farmer, A. E., Katz, R., McGuffin, P., et al (1987) A comparison between the Present State Examination and the Composite International Diagnostic Interview. Archives of General Psychiatry, 44, 10641068.CrossRefGoogle ScholarPubMed
Farmer, A. E., Jenkins, P. L., Katz, R., et al (1991) Comparison of CATEGO-derived ICD–8 and DSM–III classifications using the Composite International Diagnostic Interview in severely ill subjects. British Journal of Psychiatry, 158, 177182.CrossRefGoogle ScholarPubMed
Fawcett, J. & Kravitz, H. M. (1983) Anxiety syndromes and their relationship to depressive illness. Journal of Clinical Psychiatry, 44, 811.Google Scholar
Finlay-Jones, R. & Brown, G. W. (1981) Types of stressful life events and the onset of anxiety and depressive disorders. Psychological Medicine, 11, 803815.CrossRefGoogle ScholarPubMed
First, M. B., Spitzer, R. L. & Williams, J. B. W. (1990) Exclusionary principles and the comorbidity of psychiatric diagnoses: a historical review and implications for the future. In Comorbidity of Mood and Anxiety Disorders (eds Maser, J. D. & Cloninger, C. R.), pp. 83109. Washington, DC: APP.Google Scholar
Frances, A., Widiger, T. & Fyer, M. R. (1990) The influence of classification methods on comorbidity. In Comorbidity of Mood and Anxiety Disorders (eds Maser, J. D. & Cloninger, C. R.), pp. 4159. Washington, DC: APP.Google Scholar
Frances, A., Manning, D., Marin, D., et al (1992) Relationship of anxiety and depression. Psychopharmacology, 106, S82S86.CrossRefGoogle ScholarPubMed
Guze, S. B., Cloninger, C. R., Martin, R. L., et al (1983) A follow-up and family study of schizophrenia. Archives of General Psychiatry, 40, 12731276.CrossRefGoogle ScholarPubMed
Guze, S. B., Cloninger, C. R., Martin, R. L., et al (1986a) Alcoholism as a medical disorder. Comprehensive Psychiatry, 27, 501510.Google Scholar
Guze, S. B., Cloninger, C. R., Martin, R. L., et al (19866) A follow-up and family study of Briquet's syndrome. British Journal of Psychiatry, 149, 1723.CrossRefGoogle Scholar
Hagnell, O. (1966) A Prospective Study of the Incidence of Mental Disorder: A study based on 24,000 person years of the incidence of mental disorders in a Swedish population together with an evaluation of the aetiological significance of medical, social, and personality factors. Lund: Svenska Bokforlaget.Google Scholar
Hagnell, O., Lanke, J., Rorsman, B., et al (1982) Are we entering an age of melancholy? Depressive illness in a prospective epidemiologic study over 25 years: the Lundby Study, Sweden. Psychological Medicine, 12, 279289.Google Scholar
Hagnell, O. & Grasbeck, A. (1990) Comorbidity of anxiety and depression in the Lundby 25-year prospective study: the pattern of subsequent episodes. In Comorbidity of Mood and Anxiety Disorders (eds Maser, J. D. & Cloninger, C. R.), pp. 139152. Washington, DC: APP.Google Scholar
Hong, B., Smith, M. D., Robson, A. M., et al (1987) Depressive symptomatology and treatment in patients with end-stage renal disease. Psychological Medicine, 17, 185190.CrossRefGoogle ScholarPubMed
Janca, A., Robins, L. N. & Cottler, L. B. (1992) Clinical observation of CIDI assessments: an analysis of the CIDI field trials – wave II at the St Louis site. British Journal of Psychiatry, 160, 815818.Google Scholar
Joffe, R. T., Babgy, R. M. & Levitt, A. (1993) Anxious and nonanxious depression. American Journal of Psychiatry, 150, 12571258.Google ScholarPubMed
Kalbfleisch, J. D. & Prentice, R. L. (1980) The Statistical Analysis of Failure Time Data. New York: Wiley.Google Scholar
Kalton, G. (1977) Practical methods for estimating survey sampling errors. Bulletin of the International Statistics Institute, 47, 495514.Google Scholar
Keitner, G. I., Ryan, C. E., Miller, I. W., et al (1991) 12-month outcome of patients with major depression and comorbid psychiatric or medical illness (compound depression). American Journal of Psychiatry, 148, 345350.Google Scholar
Kendler, K. S. (1996) Major depression and generalised anxiety disorder: same genes, (partly) different environments – revisited. British Journal of Psychiatry, this issue.Google Scholar
Kendler, K. S., Neale, M. C., Kessler, R. C., et al (1992) Major depression and generalized anxiety disorder: same genes, (partly) different environments? Archives of General Psychiatry, 49, 716722.CrossRefGoogle ScholarPubMed
Kendler, K. S., Neale, M. C., Kessler, R. C., et al (1993) Major depression and phobias: the genetic and environmental sources of comorbidity. Psychological Medicine, 23, 361371.Google Scholar
Kessler, R. C., McGonagle, K. A., Swartz, M., et al (1993) Sex and depression in the National Comorbidity Survey I: lifetime prevalence, chronicity, and recurrence. Journal of Affective Disorders, 29, 8596.Google Scholar
Kessler, R. C., McGonagle, K. A., Nelson, C. B., et al (1994a) Sex and depression in the National Comorbidity Survey II: cohort effects. Journal of Affective Disorders, 30, 1526.Google Scholar
Kessler, R. C., McGonagle, K. A., Nelson, C. B., Zhao, S., et al (1994b) Lifetime and 12-month prevalence of DSM–III–R psychiatric disorders in the United States. Archives of General Psychiatry, 51, 819.Google Scholar
Kessler, R. C., Sonnega, A., Bromet, E., et al (1995) Posttraumatic stress disorder in the National Comorbidity Survey. Archives of General Psychiatry, 52, 10481060.Google Scholar
Kessler, R. C., Mroczek, D. K. & Belli, R. F. (1996) Retrospective adult assessment of childhood psychopathology. In Assessment in Child and Adolescent Psychopathology (eds Shaffer, D. & Richters, J.). New York: Guilford Press (in press).Google Scholar
Kish, L. & Frankel, M. R. (1970) Balanced repeated replications for standard errors. Journal of the American Statistical Association, 65, 10711094.CrossRefGoogle Scholar
Leitmeyer, P. (ed.) (1990) Zur Symptomerfassung mit dem standarisierten Interview CIDI-C in der Allgemeinpraxis: Inaugural Dissertation zur Erlangung des medizinischen Doktorgrades für klinische Medizin. Mannheim: Universitat Mannheim.Google Scholar
McLeod, J. D., Turnbull, J. E., Kessler, R. C., et al (1990) Sources of discrepancy in the comparison of a lay-administered diagnostic instrument with clinical diagnosis. Psychiatry Research, 31, 145159.CrossRefGoogle ScholarPubMed
Merikangas, K. R. (1990) Comorbidity for anxiety and depression: review of family and genetic studies. In Comorbidity of Mood and Anxiety Disorders (eds Maser, J. D. & Cloninger, C. R.), pp. 331348. Washington, DC: APP.Google Scholar
Mezzich, J. E., Ahn, C. W., Fabrega, H. Jr., et al (1990) Patterns of psychiatric comorbidity in a large population presenting for care. In Comorbidity of Mood and Anxiety Disorders (eds Maser, J. D. & Cloninger, C. R.), pp. 189204. Washington, DC: APP.Google Scholar
Monroe, S. M. (1990) Psychosocial factors in anxiety and depression. In Comorbidity of Mood and Anxiety Disorders (eds Maser, J. D. & Cloninger, C. R.), pp. 463497. Washington, DC: APP.Google Scholar
Murphy, J. M. (1990) Diagnostic comorbidity and symptom cooccurrence: the Stirling County Study. In Comorbidity of Mood and Anxiety Disorders (eds Maser, J. D. & Cloninger, C. R.), pp. 153176. Washington, DC: APP.Google Scholar
Pillemer, D. B., Goldsmith, L. R., Panter, A. T., et al (1988) Very long-term memories of the first year in college. Journal of Experimental Psychology: Learning, Memory and Cognition, 14, 709714.Google Scholar
Prudo, R., Harris, T. & Brown, G. W. (1984) Psychiatric disorder in a rural and an urban population, 3: social integration and the morphology of affective disorder. Psychological Medicine, 14, 327345.Google Scholar
Robins, L. N. & Guze, S. B. (1970) Establishment of diagnostic validity in psychiatric illness: Its application to schizophrenia. American Journal of Psychiatry, 126, 983987.CrossRefGoogle ScholarPubMed
Robins, L. N., Wing, J., Wittchen, H.-U., et al (1988) The Composite International Diagnostic Interview: an epidemiologic instrument suitable for use in conjunction with different diagnostic systems and in different cultures. Archives of General Psychiatry, 45, 10691077.Google Scholar
Robins, L. N. & Regier, D. A. (eds) (1991) Psychiatric Disorders in America: The Epidemiologic Catchment Area Study. New York: Free Press.Google Scholar
Robins, L. N., Locke, B. Z. & Regier, D. A. (1991) An overview of psychiatric disorders in America. In Psychiatric Disorders in America: The Epidemiologic Catchment Area Study (eds Robins, L. N. & Regier, D. A.), pp. 328366. New York: Free Press.Google Scholar
Robinson, J. A. (1992) First experience memories: Contexts and functions in personal histories. In Theoretical Perspectives on Autobiographical Memory (eds Conway, M. A., Rubin, D. C., Spinnler, H. & Wagennar, W. A.), pp. 223239. Boston: Kluwer Academic.Google Scholar
Ross, H. E., Glaser, F. B. & Germanson, T. (1988) The prevalence of psychiatric disorders in patients with alcohol and other drug problems. Archives of General Psychiatry, 45, 10231031.Google Scholar
Rounsaville, B. J., Anton, S. F., Carroll, K., et al (1991) Psychiatric diagnosis of treatment-seeking cocaine abusers. Archives of General Psychiatry, 48, 4351.Google Scholar
Sargeant, J. K., Bruce, M. L., Florio, L. P., et al (1990) Factors associated with 1-year outcome of major depression in the community. Archives of General Psychiatry, 47, 519526.Google Scholar
SAS Institute (1988) SAS 6.03. Cary, NC: SAS Institute.Google Scholar
Semler, G. (1989) Reliabilitat und Validitat des Composite International Diagnostic Interview. Inaugural-Dissertation zur Erlangung des akademischen Grades eines Doktors der Philosophic Mannheim: Universitat Mannheim.Google Scholar
Spengler, P. & Wittchen, H.-U. (1988) Procedural validity of standardized symptom questions for the assessment of psychotic symptoms: a comparison of the DIS with two clinical methods. Comprehensive Psychiatry, 29, 309322.CrossRefGoogle ScholarPubMed
Spitzer, R. & Williams, J. B. W. (1985) Classification of mental disorders. In Comprehensive Textbook of Psychiatry, Vol. 1 (4th edn) (eds Kaplan, H. & Sadlock, B.), pp. 583598. Baltimore, MD: Williams & Wilkins.Google Scholar
Torgersen, S. (1990) A twin-study perspective of the comorbidity of anxiety and depression. In Comorbidity of Mood and Anxiety Disorders (eds Maser, J. D. & Cloninger, C. R.), pp. 367378. Washington, DC: APP.Google Scholar
University of Michigan (1981) OSIRIS VII. Ann Arbor, MI: Institute for Social Research, University of Michigan.Google Scholar
US Department of Health and Human Services (1992) National Health Interview Survey: 1989 (Computer File). Hyattsville, MD: National Center for Health Statistics.Google Scholar
Wacker, H. R., Battegay, R., Mullejans, R., et al (1990) Using the CIDI-C in the general population. In Psychiatry: A World Perspective (eds Stefanis, C. N., Rabavilas, A. D. & Soldatos, C. R.), pp. 138143. Amsterdam: Elsevier Science Publishers B.Google Scholar
Weissman, M. M. (1990) Evidence for comorbidity of anxiety and depression: family and genetic studies of children. In Comorbidity of Mood and Anxiety Disorders (eds Maser, J. D. & Cloninger, C. R.), pp. 349365. Washington, DC: APP.Google Scholar
Weissman, M. M., Myers, J. K. & Harding, P. S. (1978) Psychiatric disorders in a US urban community: 1975–1976. American Journal of Psychiatry, 135, 459462.Google Scholar
Weissman, M. M., Leaf, P. J., Holzer, C. E., et al (1984) The epidemiology of depression. An update on sex differences in rates. Journal of Affective Disorders, 7, 179188.Google Scholar
Weissman, M. M. & Klerman, J. K. (1992) Depression: current understanding and changing trends. Annual Review of Public Health, 13, 319339.Google Scholar
Weissman, M. M., Bland, R., Joyce, P. R., et al (1993) Sex differences in rates of depression: Cross-national perspectives. Journal of Affective Disorders, 29, 7784.Google Scholar
Wickramaratne, P. J., Weissman, M. M., Leaf, P. J., et al (1989) Age, period and cohort effects on the risk of major depression: results from five United States communities. Journal of Clinical Epidemiology, 42, 333343.Google Scholar
Wilhelm, K. & Parker, G. (1994) Sex differences in lifetime depression rates: fact or artefact? Psychological Medicine, 24, 97111.CrossRefGoogle ScholarPubMed
Willett, J. B. & Singer, J. D. (1993) Investigating onset, cessation, relapse, and recovery: Why you should, and how you can, use discrete-time survival analysis to examine event occurrence. Journal of Consulting and Clinical Psychology, 61, 952965.Google Scholar
Wittchen, H.-U. (1994) Reliability and validity studies of the WHO-CIDI: a critical review. Journal of Psychiatric Research, 28, 5784.Google Scholar
Wittchen, H.-U., Robins, L. N., Cottler, L., et al (1990) Interrater Reliability of the Composite International Diagnostic Interview (CIDI) – Results of the Multicenter WHO/ADAMHA Field Trials (Wave I). Oxford: Excerpta Medica.Google Scholar
Wittchen, H.-U., Robins, L. N., Cottler, L., et al (1991) Cross-cultural feasibility, reliability and sources of variance in the Composite International Diagnostic Interview (CIO). British Journal of Psychiatry, 159, 645653.Google Scholar
Wittchen, H.-U., Essau, C. A., Von Zerssen, D., et al (1992) Lifetime and six-month prevalence of mental disorders in the Munich follow-up study. European Archives of Psychiatry and Clinical Neuroscience, 241, 247258.CrossRefGoogle ScholarPubMed
Wolf, A. W., Schubert, D. S. P., Patterson, M. B., et al (1988) Associations among major psychiatric diagnoses. Journal of Consulting and Clinical Psychology, 56, 292294.CrossRefGoogle ScholarPubMed
Woodruff, R. S. & Causey, B. D. (1976) Computerized method for approximating the variance of a complicated estimate. Journal of the American Statistical Association, 71, 315321.Google Scholar
World Health Organization (1990a) Composite International Diagnostic Interview (CIDI), Version 1.0. Geneva: WHO.Google Scholar
World Health Organization (1990b) International Classification of Diseases, Classification of Mental and Behavioral Disorders: Diagnostic Criteria for Research (ICD–10). Geneva: WHO.Google Scholar
World Health Organization (1991) Mental health and behavioral disorders (including disorders of psychological development). In International Classification of Diseases–10th Revision. Geneva: WHO.Google Scholar
Submit a response

eLetters

No eLetters have been published for this article.