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Cited by 726Mental Health Treatment and AccessTreatment of Major DepressionAnxiety, Depression, Psychometrics, Treatment, Cognitive Processes

Service utilization and social morbidity associated with depressive symptoms in the community

Johnson, Jim·1992·JAMA: The Journal of the American Medical Association
DOI 10.1001/jama.1992.03480110054033
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Abstract

OBJECTIVE: To estimate service utilization and social morbidity in the community associated with depressive symptoms. Estimates were made using an epidemiologic measure, population attributable risk. Population attributable risk is a compound measure reflecting both the morbid risk to an individual with a disorder and the prevalence of the disorder in the community. DESIGN: Epidemiologic survey. PARTICIPANTS: Eighteen thousand five hundred seventy-one adults in the Epidemiologic Catchment Area Study interviewed from a complex random sample in five US communities. OUTCOME MEASURES: Suicide attempts, use of psychoactive medications, self-reported physical and emotional health, time lost from work, and general medical services or use of emergency departments for emotional problems. RESULTS: Major depression-dysthymia (lifetime prevalence, 6.1%) and depressive symptoms (lifetime prevalence, 23.1%) were associated with increased service utilization and social morbidity as measured by the outcome variables. On a population basis, however, as much or more service burden and impairment was associated with depressive symptoms as with the clinical conditions of depression or dysthymia. The equal association results from the greater prevalence of depressive symptoms. Population attributable risk percentages associated with depressive symptoms (not disorder) were as follows: emergency department use (11.8%) or medical consultations for emotional problems (21.5%); use of tranquilizers (14.6%), sleeping pills (21.0%), or antidepressants (22.2%); fair or poor self-reported emotional health (15.3%); days lost from work (17.8%); and suicide attempts (25.0%). CONCLUSIONS: Estimates of population attributable risk indicated that physicians actually provided services to more persons with depressive symptoms than to persons with formally defined conditions of depressive disorders. Subclinical depression, as a consequence of high prevalence, is a clinical and public health problem. Attention to diagnostic and treatment issues is indicated.

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  • Twenty-three percent of Americans report depressive symptoms below the threshold of major depression over their lifetime.

    “Twenty-three percent of Americans report depressive symptoms below the threshold of major depression over their lifetime [7].”

    From Treatment of somatization in primary care (1997) · cites this paper as [7]

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Authors
Johnson, J.
Affiliations
Columbia University (US)
Corresponding author
Johnson, Jim
Venue
JAMA: The Journal of the American Medical Association
Publisher
American Medical Association (AMA)
Published
1992-03-18
Volume
267
Issue
11
Pages
1478
ISSN
  • 0002-9955 (ISSN-L)
  • 0098-7484
DOI
10.1001/jama.1992.03480110054033
OpenAlex
W2005571121
Cited by
726
References
22
Citations by year
2025: 5 · 2024: 6 · 2023: 2 · 2022: 3 · 2021: 6 · 2020: 7 · 2019: 12 · 2018: 7 · 2017: 9 · 2016: 14 · 2015: 8 · 2014: 16 · 2013: 22 · 2012: 18
FWCI
59.12
Type
journal article
Language
en
Open access
closed
Locations
  • JAMA (publishedVersion)
  • PubMed (publishedVersion)
Funders
  • National Institutes of Health (5r01mh043525-02)
  • National Institute of Mental Health (5R01 MH43525-02)
Topics
  • Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
  • Health Sciences › Medicine › Pharmacology › Treatment of Major Depression
  • Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
Keywords
depressive symptoms, subthreshold depression, major depressive disorder, dysthymia, service utilization, population attributable risk, emergency department utilization, antidepressants, tranquilizers, hypnotics, suicide attempts, absenteeism, community prevalence, Epidemiologic Catchment Area study
MeSH terms
Absenteeism, Adolescent, Adult, Aged, Mental Disorders, Catchment Area, Health, Depression, Depressive Disorder, Emergency Service, Hospital, Female, Humans, Male, Mental Health Services, Middle Aged, Office Visits, Risk, United States, Comorbidity, Prevalence, Treatment Outcome

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