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Cited by 1,737Mental Health Treatment and AccessTreatment of Major DepressionAnxiety, Depression, Psychometrics, Treatment, Cognitive Processes

Epidemiology of Adult DSM-5 Major Depressive Disorder and Its Specifiers in the United States

Open access
Hasin, Deborah S., Sarvet, Aaron L., Meyers, Jacquelyn L., Saha, Tulshi D., Ruan, W. June, Stohl, Malka, Grant, Bridget F.·2018·JAMA Psychiatry
DOI 10.1001/jamapsychiatry.2017.4602PMC PMC5875313
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Abstract

Importance: No US national data are available on the prevalence and correlates of DSM-5-defined major depressive disorder (MDD) or on MDD specifiers as defined in DSM-5. Objective: To present current nationally representative findings on the prevalence, correlates, psychiatric comorbidity, functioning, and treatment of DSM-5 MDD and initial information on the prevalence, severity, and treatment of DSM-5 MDD severity, anxious/distressed specifier, and mixed-features specifier, as well as cases that would have been characterized as bereavement in DSM-IV. Design, Setting, and Participants: In-person interviews with a representative sample of US noninstitutionalized civilian adults (≥18 years) (n = 36 309) who participated in the 2012-2013 National Epidemiologic Survey on Alcohol and Related Conditions III (NESARC-III). Data were collected from April 2012 to June 2013 and were analyzed in 2016-2017. Main Outcomes and Measures: Prevalence of DSM-5 MDD and the DSM-5 specifiers. Odds ratios (ORs), adjusted ORs (aORs), and 95% CIs indicated associations with demographic characteristics and other psychiatric disorders. Results: Of the 36 309 adult participants in NESARC-III, 12-month and lifetime prevalences of MDD were 10.4% and 20.6%, respectively. Odds of 12-month MDD were significantly lower in men (OR, 0.5; 95% CI, 0.46-0.55) and in African American (OR, 0.6; 95% CI, 0.54-0.68), Asian/Pacific Islander (OR, 0.6; 95% CI, 0.45-0.67), and Hispanic (OR, 0.7; 95% CI, 0.62-0.78) adults than in white adults and were higher in younger adults (age range, 18-29 years; OR, 3.0; 95% CI, 2.48-3.55) and those with low incomes ($19 999 or less; OR, 1.7; 95% CI, 1.49-2.04). Associations of MDD with psychiatric disorders ranged from an aOR of 2.1 (95% CI, 1.84-2.35) for specific phobia to an aOR of 5.7 (95% CI, 4.98-6.50) for generalized anxiety disorder. Associations of MDD with substance use disorders ranged from an aOR of 1.8 (95% CI, 1.63-2.01) for alcohol to an aOR of 3.0 (95% CI, 2.57-3.55) for any drug. Most lifetime MDD cases were moderate (39.7%) or severe (49.5%). Almost 70% with lifetime MDD had some type of treatment. Functioning among those with severe MDD was approximately 1 SD below the national mean. Among 12.9% of those with lifetime MDD, all episodes occurred just after the death of someone close and lasted less than 2 months. The anxious/distressed specifier characterized 74.6% of MDD cases, and the mixed-features specifier characterized 15.5%. Controlling for severity, both specifiers were associated with early onset, poor course and functioning, and suicidality. Conclusions and Relevance: Among US adults, DSM-5 MDD is highly prevalent, comorbid, and disabling. While most cases received some treatment, a substantial minority did not. Much remains to be learned about the DSM-5 MDD specifiers in the general population.

Integrity signals

Registry

Crossref · 10.1001/jamapsychiatry.2017.4602

Cites

106 of 106 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

20 of 68 cited sources checked · 5 supported · 1 flagged · accuracy not yet measured

  • Premisecitation

    Demographic correlates of MDD were consistent with previous surveys.

    “Demographic correlates were consistent with previous surveys.2,5”
    Quote in the paperNot a substantial claim1 of 2 sources checked
    • cites [2] 2. Mojtabai R, Olfson M, Han B. National trends in the prevalence and treatment of depression in adolescents and young adults. Pediatrics. 2016; 138(6):pii:e20161878. source

      The Results (page not available in our copy) identify sociodemographic correlates of major depressive episodes in adolescents and young adults. The Discussion says the larger increase among girls than boys aligns with past studies, but it does not establish that the demographic correlates overall were consistent with previous surveys. The paper reports major depressive episodes, rather than MDD diagnoses. (LLM, conf=0.82)

      Experimental — accuracy not yet measured
    • cites [5] 5. Hasin DS, Goodwin RD, Stinson FS, Grant BF. Epidemiology of major depressive disorder: results from the National Epidemiologic Survey on Alcoholism and Related Conditions. Arch Gen Psychiatry. 2005;62(10):1097-1106. source
  • Findingcitation

    MDD was associated with substance use disorders, particularly drug disorders.

    “Major depressive disorder was assoc iated w ith SUDs, particularly drug disorders, as found previously for cannabis, 40,62 nonmedical prescription opioids, 5,57,63 and drug use disorders.41”
    Quote in the paperNot a substantial claim2 of 6 sources checked
    • cites [40] 40. Grant BF, Saha TD, Ruan WJ, et al. Epidemiology of DSM-5 drug use disorder: results from the National Epidemiologic Survey on Alcohol and Related Conditions-III. JAMA Psychiatry. 2016;73(1): 39-47.

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

    • cites [62] 62. Martins SS, Fenton MC, Keyes KM, Blanco C, Zhu H, Storr CL. Mood/anxiety disorders and their association with non-medical prescription opioid use and prescription opioid use disorder: longitudinal evidence from the National Epidemiologic Study on Alcohol and Related Conditions. Psychol Med. 2012;42(6):1261-1272. source
    • cites [5] 5. Hasin DS, Goodwin RD, Stinson FS, Grant BF. Epidemiology of major depressive disorder: results from the National Epidemiologic Survey on Alcoholism and Related Conditions. Arch Gen Psychiatry. 2005;62(10):1097-1106. source
    • cites [57] 57. Mehta K, Kramer H, Durazo-Arvizu R, Cao G, Tong L, Rao M. Depression in the US population during the time periods surrounding the Great Recession. J Clin Psychiatry. 2015;76(4):e499-e504. source
    • cites [63] 63. Compton WM, Han B, Jones CM, Blanco C, Hughes A. Marijuana use and use disorders in adults in the USA, 2002-14. Lancet Psychiatry. 2016;3(10): 954-964. source
    • cites [41] 41. Saha TD, Kerridge BT, Goldstein RB, et al. Nonmedical prescription opioid use and DSM-5 nonmedical prescription opioid use disorder in the United States. J Clin Psychiatry. 2016;77(6):772-780. source

      The Results > Comorbidity section (page unavailable) reports an association between nonmedical prescription opioid use and major depressive disorder, limited to 12-month MDD. It does not report that MDD was associated with nonmedical prescription opioid use disorder, or establish that the association was particularly strong for drug disorders. (LLM, conf=0.86)

      Experimental — accuracy not yet measured
  • Interpretationreasoning

    MDD comorbidity with substance use disorders remains a substantial public health and economic burden.

    “With increasingly positive attitudes toward substance use [64][65][66] and increasing rates of adult SUDs and associated problems, 24,41,42,[67][68][69] MDD comorbidity with SUDs remains a substantial public health 24,70 and economic 16 burden.”
    Quote in the paperNot a substantial claim1 of 3 sources checked
    • cites [24] 24. Grant BF, Goldstein RB, Saha TD, et al. Epidemiology of DSM-5 alcohol use disorder: results from the National Epidemiologic Survey on Alcohol and Related Conditions III. JAMA Psychiatry. 2015; 72(8):757-766.

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

    • cites [70] 70. Bonn-Miller MO, Boden MT, Bucossi MM, Babson KA. Self-reported cannabis use characteristics, patterns and helpfulness among medical cannabis users. Am J Drug Alcohol Abuse. 2014;40(1):23-30. source
    • cites [16] 16. Greenberg PE, Fournier AA, Sisitsky T, Pike CT, Kessler RC. The economic burden of adults with major depressive disorder in the United States (2005 and 2010). J Clin Psychiatry. 2015;76(2): 155-162. source

      The Discussion reports a substantial economic burden among people with MDD and attributes a large share to comorbid conditions. The Demographics section identifies alcohol and drug abuse as comorbidities, but the paper does not isolate the economic burden of MDD comorbid with substance use disorders. In the citing sentence, this source is attached to the economic-burden claim; the public-health claim has separate citations. (LLM, conf=0.83)

      Experimental — accuracy not yet measured
  • Premisecitation

    Over the past 25 years, the US prevalence of adolescent and adult depression indicators has increased.

    “O ver the past 25 years, the US prevalence of adolescent and adult depression indicators has increased.1,2”
    Quote in the paperNot a substantial claim1 of 2 sources checked
    • cites [1] 1. Case A, Deaton A. Rising morbidity and mortality in midlife among white non-Hispanic Americans in the 21st century. Proc Natl Acad Sci U S A. 2015;112 (49):15078-15083. source
    • cites [2] 2. Mojtabai R, Olfson M, Han B. National trends in the prevalence and treatment of depression in adolescents and young adults. Pediatrics. 2016; 138(6):pii:e20161878. source

      The Abstract and Results report increased 12-month major depressive episode prevalence among US adolescents and young adults from 2005 to 2014. The study does not establish a 25-year trend or an increase among adults generally; the Discussion says the increase was limited to ages 12–20, with no change at ages 21–25. (LLM, conf=0.91)

      Experimental — accuracy not yet measured
  • Study design and conductcitation

    Test-retest reliability of the AUDADIS-5 DSM-5 MDD diagnosis was fair (κ = 0.40).

    “Test-retest reliability of AUDADIS-5 DSM-5 MDD was fair 29 (κ = 0.40) 26”
    Quote in the paperNot a substantial claim1 of 2 sources checked
    • cites [26] 26. National Institute on Alcohol Abuse and Alcoholism. National Epidemiologic Survey on Alcohol and Related Conditions-III (NESARC-III). https://niaaa.nih.gov/research/nesarc-III. Accessed October 5, 2017.

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

    • cites [29] 29. Hasin DS, Shmulewitz D, Stohl M, et al. Procedural validity of the AUDADIS-5 depression, anxiety and post-traumatic stress disorder modules. Drug Alcohol Depend. 2015;152:246-256. source

      The Introduction says AUDADIS-5 mood and anxiety disorders had test–retest reliability comparable to AUDADIS-IV, but gives no κ = 0.40 for DSM-5 MDD. Its κ = 0.40–0.65 range refers to AUDADIS-IV diagnoses. The Results (§3.2) instead report AUDADIS-5/PRISM-5 concordance, a different comparison. (LLM, conf=0.86)

      Experimental — accuracy not yet measured
  • May combine two claims. 25
  • Classified as probably not a substantial claim. 15
  • The quote only partly states this claim. 15

  • May combine two claims.

    Interpretationcitation

    MDD was more prevalent among women, possibly related to gender discrimination, differential exposure to childhood or adult adversities such as sexual abuse, differential exposure to a complex host of different developmentally organized risk factors, or biologically different stress responses.

    “Major depressive disorder was more prevalent among women, possibly related to gender discrimination, 50 differential exposure to childhood or adult adversities 51 such as sexual abuse, 52 differential exposure to a complex host of different developmentally organized risk factors, 53 or biologically different stress responses.54”
    Quote in the paperNot a substantial claim2 of 3 sources checked
    • cites [50] 50. McLaughlin KA, Conron KJ, Koenen KC, Gilman SE. Childhood adversity, adult stressful life events, and risk of past-year psychiatric disorder. Psychol Med. 2010;40(10):1647-1658. source

      Citation 51 is attached to differential exposure to childhood or adult adversities as a possible explanation for higher depression prevalence among women. The Results section, “Prevalence of Childhood Adversities and Stressful Life Events” (page unavailable), says childhood-adversity exposure was similar among men and women and found no gender differences in the prevalence of minor or major life events. The Discussion considers differences in event severity, but does not offer differential exposure as an explanation for higher depression prevalence among women. (LLM, conf=0.87)

      Checked by a reasoning model — may be wrong.

      Experimental — accuracy not yet measured
    • cites [51] 51. Weiss EL, Longhurst JG, Mazure CM. Childhood sexual abuse as a risk factor for depression in women: psychosocial and neurobiological correlates. Am J Psychiatry. 1999;156(6):816-828. source
    • cites [52] 52. Kendler KS, Gardner CO. Sex differences in the pathways to major depression: a study of opposite-sex twin pairs. Am J Psychiatry. 2014; 171(4):426-435. source

      Citation 53 attaches to the proposed role of developmentally organized risk factors. The Discussion reports sex differences across developmental tiers of the model, supporting that part of the claim. It describes differences in the factors’ effects on depression risk, however, rather than showing that differential exposure to those factors explains the higher prevalence of depression among women. (LLM, conf=0.84)

      Experimental — accuracy not yet measured

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    The DSM-IV diagnosis of MDD was associated with impairment, psychiatric and substance use disorders, poor health, mortality, disease and economic burden, and disability-years.

    “The DSM-IV diagnosis of MDD was associated with impairment, 3,4 psychiatric and substance use disorders (SUDs), [5][6][7][8][9] poor health, 10,11 mortality, 12 disease and economic burden, 12 and disability-years.[13][14][15][16]”
    Quote in the paperNot a substantial claim1 of 9 sources checked
    • cites [3] 3. Spijker J, Graaf R, Bijl RV, Beekman AT, Ormel J, Nolen WA. Functional disability and depression in the general population: results from the Netherlands Mental Health Survey and Incidence Study (NEMESIS). Acta Psychiatr Scand. 2004; 110(3):208-214. source

      The Discussion reports worse functioning during depression and improvement after recovery, supporting the impairment portion of the sentence. However, the Diagnostic instrument section specifies DSM-III-R diagnoses, not the DSM-IV diagnosis named in the claim. The other outcomes are attached to different citations in the citing sentence and are not assessed here. (LLM, conf=0.86)

      Experimental — accuracy not yet measured
    • cites [4] 4. Kessler RC, Bromet EJ. The epidemiology of depression across cultures. Annu Rev Public Health. 2013;34:119-138.

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

    • cites [5] 5. Hasin DS, Goodwin RD, Stinson FS, Grant BF. Epidemiology of major depressive disorder: results from the National Epidemiologic Survey on Alcoholism and Related Conditions. Arch Gen Psychiatry. 2005;62(10):1097-1106. source
    • cites [6] 6. Regier DA, Farmer ME, Rae DS, et al. Comorbidity of mental disorders with alcohol and other drug abuse: results from the Epidemiologic Catchment Area (ECA) Study. JAMA. 1990;264(19): 2511-2518. source
    • cites [7] 7. Kessler RC, McGonagle KA, Zhao S, et al. Lifetime and 12-month prevalence of DSM-III-R psychiatric disorders in the United States: results from the National Comorbidity Survey. Arch Gen Psychiatry. 1994;51(1):8-19.

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

    • cites [8] 8. Grant BF, Harford TC. Comorbidity between DSM-IV alcohol use disorders and major depression. Drug Alcohol Depend. 1995;39(3):197-206. source
    • cites [9] 9. Kessler RC, Berglund P, Demler O, et al; National Comorbidity Survey Replication. The epidemiology of major depressive disorder: results from the National Comorbidity Survey Replication (NCS-R). JAMA. 2003;289(23):3095-3105. source
    • cites [10] 10. Goldstein BI, Carnethon MR, Matthews KA, et al; American Heart Association Atherosclerosis; Hypertension and Obesity in Youth Committee of the Council on Cardiovascular Disease in the Young. Major depressive disorder and bipolar disorder predispose youth to accelerated atherosclerosis and early cardiovascular disease. Circulation. 2015; 132(10):965-986. source
    • cites [11] 11. Vancampfort D, Mitchell AJ, De Hert M, et al. Type 2 diabetes in patients with major depressive disorder. Depress Anxiety. 2015;32(10):763-773. source

  • May combine two claims.

    Premisecitation

    The SF-12v2 is a reliable, valid, widely used measure of impairment in the prior 30 days.

    “Impaired functioning was assessed with version 2 of the 12-Item Short Form Health Survey (SF-12v2), a reliable, valid, widely used measure of impairment in the prior 30 days.39”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [39] 39. Hasin DS, Kerridge BT, Saha TD, et al. Prevalence and correlates of DSM-5 cannabis use disorder, 2012-2013: findings from the National Epidemiologic Survey on Alcohol and Related Conditions-III. Am J Psychiatry. 2016;173(6):588-599. source

      The Method > Disability/Impairment passage describes the SF-12v2 as a widely used measure of current disability and says the study used it to assess functioning. It does not specify a prior-30-day period or state that the SF-12v2 is reliable and valid; the reliability and validity statements in Method > Assessments concern a different interview. (LLM, conf=0.87)

      Experimental — accuracy not yet measured

  • May combine two claims.

    Premisecitation

    Efforts to self-manage depression with cannabis are increasing despite lack of evidence that cannabinoids are effective for this purpose, and prospectively cannabis worsens the course of depressive disorders.

    “Evidence suggests that efforts to selfmanage depression with cannabis are increasing [71][72][73][74][75] (also Aaron L. Sarvet, MPH, written communication, January 2, 2018) despite lack of evidence that cannabinoids are effective for this purpose 76,77 ; prospectively, cannabis worsens the course of depressive disorders.78”
    Quote in the paperNot a substantial claim4 of 8 sources checked
    • cites [71] 71. Corroon JM Jr, Mischley LK, Sexton M. Cannabis as a substitute for prescription drugs. J Pain Res. 2017;10:989-998. source

      The Results (Comorbidities) report that respondents used cannabis to manage depression, supporting the self-management part of the cited clause. This cross-sectional study does not establish that such efforts are increasing over time. The statements about effectiveness and the prospective course of depression have separate citations and are not attributed to this source. (LLM, conf=0.85)

      Experimental — accuracy not yet measured
    • cites [72] 72. Nunberg H, Kilmer B, Pacula RL, Burgdorf J. An analysis of applicants presenting to a medical marijuana specialty practice in California. J Drug Policy Anal. 2011;4(1):pii:1. source

      The Results section, “Applicants’ Self Reports of the Therapeutic Benefits of Marijuana” (page unavailable), reports that 26.1% of applicants said they used marijuana for relief of depression. That supports the self-management portion of the clause to which this source is cited, but the paper does not establish that such efforts are increasing. The separate claims about efficacy and the prospective course of depression carry different citations in the citing sentence and are not attributed to this source. (LLM, conf=0.88)

      Experimental — accuracy not yet measured
    • cites [73] 73. Bradford AC, Bradford WD. Medical marijuana laws may be associated with a decline in the number of prescriptions for Medicaid enrollees. Health Aff (Millwood). 2017;36(5):945-951. source
    • cites [74] 74. Bradford AC, Bradford WD. Medical marijuana laws reduce prescription medication use in Medicare Part D. Health Aff (Millwood). 2016;35(7): 1230-1236. source
    • cites [75] 75. Whiting PF, Wolff RF, Deshpande S, et al. Cannabinoids for medical use: a systematic review and meta-analysis. JAMA. 2015;313(24):2456-2473. source
    • cites [76] 76. National Academies of Sciences, Engineering, and Medicine. The Health Effects of Cannabis and Cannabinoids: The Current State of Evidence and Recommendations for Research. Washington, DC: National Academies Press; 2017.

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

    • cites [77] 77. Bahorik AL, Leibowitz A, Sterling SA, Travis A, Weisner C, Satre DD. Patterns of marijuana use among psychiatry patients with depression and its impact on recovery. J Affect Disord. 2017;213:168-171. source
    • cites [78] 78. Han B, Olfson M, Mojtabai R. Depression care among depressed adults with and without comorbid substance use disorders in the United States. Depress Anxiety. 2017;34(3):291-300. source

  • Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing).

    Interpretationcitation

    The NESARC-III treatment rates are plausible given the extent of direct-to-consumer advertising of antidepressants and widespread distribution through primary care.

    “The NESARC-III treatment rates are plausible given the extent of direct-toconsumer advertising of antidepressants 83 and widespread distribution through primary care.79”
    Quote in the paperNot a substantial claim1 of 2 sources checked
    • cites [83] 83. Qaseem A, Barry MJ, Kansagara D; Clinical Guidelines Committee of the American College of Physicians. Nonpharmacologic versus pharmacologic treatment of adult patients with major depressive disorder: a clinical practice guideline from the American College of Physicians. Ann Intern Med. 2016;164(5):350-359. source
    • cites [79] 79. Olfson M, Blanco C, Marcus SC. Treatment of adult depression in the United States. JAMA Intern Med. 2016;176(10):1482-1491. source

  • May combine two claims.

    Findingnone given

    MDD was associated with anxiety disorders, particularly panic disorder and generalized anxiety disorder, as well as with PTSD.

    “Major depressive disorder was associated with anxiety disorders, particularly panic disorder and generalized anxiety disorder, as well as with PTSD.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Further adjusting for psychiatric comorbidity reduced associations by a factor of approximately 50%, although odds ratios remained statistically significant.

    “Further adjusting for psychiatric comorbidity reduced asso-ciations by a factor of approximately 50%, although ORs remained statistically significant.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Few MDD cases were mild; most were moderate or severe.

    “Few were mild; most were moderate or severe.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Additional adjustment for other psychiatric disorders decreased all adjusted odds ratios, but most remained significant.

    “Additional adjustment for other psychiatric disorders decreased all aORs (some substantially), but most remained significant.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingcitation

    This study found an association between low income and 12-month MDD, consistent with other studies conducted within the last 3 years.

    “This study found association between low income and 12-month MDD, consistent with other studies conducted within the last 3 years.1,57,58”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [1] 1. Case A, Deaton A. Rising morbidity and mortality in midlife among white non-Hispanic Americans in the 21st century. Proc Natl Acad Sci U S A. 2015;112 (49):15078-15083. source
    • cites [57] 57. Mehta K, Kramer H, Durazo-Arvizu R, Cao G, Tong L, Rao M. Depression in the US population during the time periods surrounding the Great Recession. J Clin Psychiatry. 2015;76(4):e499-e504. source
    • cites [58] 58. Galea S, Annas GJ. Aspirations and strategies for public health. JAMA. 2016;315(7):655-656. source

  • May combine two claims.

    Findingcitation

    Of participants with lifetime DSM-5 MDD, 69.4% received any treatment for their disorder, slightly higher than the 60.6% in the 2001-2002 NESARC.

    “Of participants with lifetime DSM-5 MDD, 69.4% received any treatment for their disorder, slightly higher than in the 2001-2002 NESARC (60.6%).5”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [5] 5. Hasin DS, Goodwin RD, Stinson FS, Grant BF. Epidemiology of major depressive disorder: results from the National Epidemiologic Survey on Alcoholism and Related Conditions. Arch Gen Psychiatry. 2005;62(10):1097-1106. source

  • The quote only partly states this claim.

    Findingown data

    The odds of 12-month MDD were higher in younger adults aged 18-29 years than in adults aged 65 years or older (OR, 3.0; 95% CI, 2.48-3.55).

    “were higher in younger adults (age range, 18-29 years; OR, 3.0; 95% CI, 2.48-3.55)”
    • Also stated in: § DSM-5 MDD Prevalence and Sociodemographic Correlates · plain
      “Compared with respondents 65 years or older, odds of 12month MDD were greater for younger age groups.”
    Quote in the paperNot a substantial claim

  • The quote only partly states this claim.

    Findingown data

    The odds of 12-month MDD were higher in adults with low incomes ($19,999 or less) than in the highest income category (OR, 1.7; 95% CI, 1.49-2.04).

    “those with low incomes ($19 999 or less; OR, 1.7; 95% CI, 1.49-2.04)”
    • Also stated in: § DSM-5 MDD Prevalence and Sociodemographic Correlates · plain
      “Compared with the highest income category ($70 000 or higher), odds of 12-month MDD were greater in each successively lower household income category”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingnone given

    Greater prevalence of MDD was found among younger adults and among white adults and Native American adults than among African American, Asian American, and Hispanic adults.

    “Greater prevalence was found among younger adults and among white adults and Native American adults than among African American, Asian American, and Hispanic adults.”
    Quote in the paperNot a substantial claim

  • The quote only partly states this claim.

    Findingown data

    The mixed-features specifier characterized 15.5% of MDD cases.

    “the mixed-features specifier characterized 15.5%.”
    • Also stated in: § DSM-5 Specifiers and Bereavement · plain
      “the mixed-features specifier characterized 15.5% of those with lifetime MDD”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Controlling for severity, both the anxious/distressed and mixed-features specifiers were associated with early onset, poor course and functioning, and suicidality.

    “Controlling for severity, both specifiers were associated with early onset, poor course and functioning, and suicidality.”
    • Also stated in: § DSM-5 Specifiers and Bereavement · plain
      “Both specifiers were significantly associated with earlier onset, number of episodes, longest duration, severity, MDD treatment overall and by type, suicidality, and poorer SF-12v2 scores.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingnone given

    While many with MDD receive treatment, others remain untreated.

    “While many with MDD receive treatment, others remain untreated.”
    Quote in the paperNot a substantial claim

  • The quote only partly states this claim.

    Findingown data

    Among participants with MDD that began in the past 12 months, 44.01% received talk therapy with a professional.

    “Talk therapy with a professional | 62.49 (0.79) | 44.01 (2.95)”
    Quote in the paperNot a substantial claim

  • The quote only partly states this claim.

    Findingown data

    Among participants with MDD in the past 12 months, the mean mental health score was 42.29, compared with 53.12 among those with no lifetime MDD (P < .001).

    “Any MDD (n = 448) | 42.29 (0.71) | <.001 | 43.85 (0.80) | <.001 | 42.94 (0.70) | <.001 | 42.10 (0.76) | <.001”
    Quote in the paperNot a substantial claim

  • The quote only partly states this claim.

    Findingown data

    Among participants with MDD that began in the past 12 months, 32.05% wanted to die.

    “Wanted to die | 46.74 (0.91) | 32.05 (2.45)”
    Quote in the paperNot a substantial claim

  • The quote only partly states this claim.

    Findingown data

    Among participants with lifetime MDD, the mixed-features specifier was associated with a longer median duration of longest or only lifetime episode (51.41 vs 25.70 weeks, P < .001).

    “Mixed-Features Specifier c | No Yes | (n = 6235) (n = 1197) | 29.60 (0.22) 26.11 (0.47) | 3.69 (0.12) 4.81 (0.36) | 25.70 (0.12) 51.41 (0.39)”
    Quote in the paperSubstantial claim

  • The quote only partly states this claim.

    Findingown data

    Among participants with lifetime MDD, the mixed-features specifier was associated with a younger mean age at onset of first episode (26.11 vs 29.60 years, P < .001).

    “Mixed-Features Specifier c | No Yes | (n = 6235) (n = 1197) | 29.60 (0.22) 26.11 (0.47) | 3.69 (0.12) 4.81 (0.36) | 25.70 (0.12) 51.41 (0.39)”
    Quote in the paperSubstantial claim

  • May combine two claims. The quote only partly states this claim.

    Findingown data

    Among participants with MDD in the past 12 months, the mean mental component summary score was 42.10, compared with 52.16 among those with no lifetime MDD (P < .001).

    “Any MDD (n = 448) | 42.29 (0.71) | <.001 | 43.85 (0.80) | <.001 | 42.94 (0.70) | <.001 | 42.10 (0.76) | <.001”
    Quote in the paperSubstantial claim

  • The quote only partly states this claim.

    Findingown data

    Among participants with lifetime MDD, the mixed-features specifier was associated with a higher mean number of lifetime episodes (4.81 vs 3.69, P < .001).

    “Mixed-Features Specifier c | No Yes | (n = 6235) (n = 1197) | 29.60 (0.22) 26.11 (0.47) | 3.69 (0.12) 4.81 (0.36) | 25.70 (0.12) 51.41 (0.39)”
    Quote in the paperSubstantial claim

  • The quote only partly states this claim.

    Findingown data

    Among participants with MDD that began in the past 12 months, 28.79% thought a lot about their own death.

    “Thought a lot about one's own death | 34.78 (0.72) | 28.79 (2.69)”
    Quote in the paperNot a substantial claim

  • The quote only partly states this claim.

    Findingown data

    Among participants with MDD in the past 12 months, the mean role-emotional functioning score was 42.94, compared with 49.31 among those with no lifetime MDD (P < .001).

    “Any MDD (n = 448) | 42.29 (0.71) | <.001 | 43.85 (0.80) | <.001 | 42.94 (0.70) | <.001 | 42.10 (0.76) | <.001”
    Quote in the paperNot a substantial claim

  • The quote only partly states this claim.

    Findingown data

    Among participants with MDD in the past 12 months, the mean social functioning score was 43.85, compared with 51.65 among those with no lifetime MDD (P < .001).

    “Any MDD (n = 448) | 42.29 (0.71) | <.001 | 43.85 (0.80) | <.001 | 42.94 (0.70) | <.001 | 42.10 (0.76) | <.001”
    Quote in the paperSubstantial claim

  • The quote only partly states this claim.

    Findingown data

    Among participants with MDD that began in the past 12 months, 22.75% thought a lot about suicide.

    “Thought a lot about suicide | 39.31 (0.80) | 22.75 (2.19)”
    Quote in the paperNot a substantial claim

  • The quote only partly states this claim.

    Findingown data

    Among participants with MDD that began in the past 12 months, 4.77% attempted suicide.

    “Attempted suicide | 13.62 (0.58) | 4.77 (1.09)”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationown data

    Among US adults, DSM-5 MDD is highly prevalent, comorbid, and disabling.

    “Among US adults, DSM-5 MDD is highly prevalent, comorbid, and disabling.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Study design and conductown data

    Comparing participants with the total eligible sample, no significant differences were found in percentages of African American, Asian, or Hispanic individuals or in population density, vacancy rate, or proportion in group quarters or renters.

    “Comparing participants with the total eligible sample (including nonrespondents), no significant differences were found in percentages of African American, Asian, or Hispanic individuals or in population density, vacancy rate, or proportion in group quarters or renters.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationreasoning

    While most cases of lifetime MDD received some treatment, a substantial minority did not.

    “While most cases received some treatment, a substantial minority did not.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationreasoning

    MDD remains a widespread, serious US health problem.

    “Therefore, MDD remains a widespread, serious US health problem.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    The total response rate of NESARC-III was 60.1%.

    “The total response rate was 60.1%.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S2 (checkable).

    Interpretationreasoning

    The high prevalence of MDD among US adults is a substantial concern given the personal, public health, and economic burdens that the disorder imposes.

    “The high prevalence of MDD among US adults is a substantial concern given the personal, public health, and economic burdens that the disorder imposes.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductreasoning

    AUDADIS-5 used a slightly different algorithm for PTSD than the final DSM-5 definition.

    “AUDADIS-5 used a slightly different algorithm for PTSD than the final DSM-5 definition, caused by a last-minute DSM-5 change that occurred too late to implement in NESARC-III.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    NESARC-III response rates compare favorably with other recent national health surveys.

    “However, NESARC-III response rates compare favorably with other recent national health surveys.[86][87][88]”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [86] 86. Fahimi M, Link M, Mokdad A, Schwartz DA, Levy P. Tracking chronic disease and risk behavior prevalence as survey participation declines. Prev Chronic Dis. 2008;5(3):A80.

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

    • cites [87] 87. Center for Behavioral Health Statistics and Quality. 2015 National Survey on Drug Use and Health: Methodological Summary and Definitions. Rockville, MD: Substance Abuse and Mental Health Services Administration; 2016.

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

    • cites [88] 88. Simon NM, Shear KM, Thompson EH, et al. The prevalence and correlates of psychiatric comorbidity in individuals with complicated grief. Compr Psychiatry. 2007;48(5):395-399. source

  • May combine two claims.

    Premisecitation

    The NESARC-III treatment rate is higher than the treatment rate in one recent study that used less specific measures to identify depression but is consistent with rates from other studies published in the last 4 years.

    “This result is higher than the treatment rate in one recent study 80 that used less specific measures to identify depression but is consistent with rates from other studies published in the last 4 years.81,82”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [80] 80. Olfson M, Kroenke K, Wang S, Blanco C. Trends in office-based mental health care provided by psychiatrists and primary care physicians. J Clin Psychiatry. 2014;75(3):247-253. source
    • cites [81] 81. Han B, Hedden S, Lipari R, Copello E, Kroutil L. Receipt of Services for Behavioral Health Problems: Results From the 2014 National Survey on Drug Use and Health. Rockville, MD: Substance Abuse and Mental Health Services Administration; 2015.

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

    • cites [82] 82. Avery RJ, Eisenberg MD, Simon KI. The impact of direct-to-consumer television and magazine advertising on antidepressant use. J Health Econ. 2012;31(5):705-718. source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductreasoning

    The symptom-count approach enabled examination of the association between severity levels and SF-12v2 impairment scores.

    “This approach enabled us to examine the association between these severity levels and SF-12v2 impairment scores.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Dual-focused treatment is more effective when two disorders are present.

    “However, dual-focused treatment is more effective when 2 disorders are present.70”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [70] 70. Bonn-Miller MO, Boden MT, Bucossi MM, Babson KA. Self-reported cannabis use characteristics, patterns and helpfulness among medical cannabis users. Am J Drug Alcohol Abuse. 2014;40(1):23-30. source

  • May combine two claims.

    Interpretationreasoning

    Removing the bereavement exclusion in DSM-5 could have accounted for a small amount of the prevalence increase in NESARC-III, but not for all of it.

    “Removing the bereavement exclusion in DSM-5 could have accounted for a small amount of the prevalence increase in NESARC-III, but not for all of it by any means.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductnone given

    The study was cross-sectional; associations do not necessarily indicate causal relationships.

    “The study was cross-sectional; associations do not necessarily indicate causal relationships.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductnone given

    The definition of the anxious/distressed specifier used a lower threshold than DSM-5, which may have somewhat inflated the rates.

    “Our definition of the anxious/ distressed specifier used a lower threshold than DSM-5, which may have somewhat inflated the rates, an issue meriting future study using different data.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Premisecitation

    DSM-5 left differentiating MDD from normal bereavement to clinical judgment.

    “Also, as noted, 85 DSM-5 left differentiating MDD from normal bereavement to clinical judgment.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [85] 85. Curtin SC, Warner M, Hedegaard H. Increase in suicide in the United States, 1999-2014. NCHS Data Brief. 2016;(241):1-8.

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing).

    Study design and conductreasoning

    The limitations of the study are offset by the large sample, reliable and valid measures of psychiatric and substance disorders, and rigorous study methods.

    “These limitations are offset by the large sample, reliable and valid measures of psychiatric and substance disorders, and rigorous study methods.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductnone given

    Lifetime associations of MDD with other psychiatric disorders may be influenced by recall bias, although this possibility is less likely for 12-month findings, which were similar.

    “Lifetime associations of MDD with other psychiatric disorders may be influenced by recall bias, although this possibility is less likely for 12-month findings, which were similar.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Study design and conductreasoning

    Some groups were not included (eg, homeless and prisoners), so NESARC-III may underestimate MDD prevalence.

    “Some groups were not included (eg, homeless and prisoners), so NESARC-III may underestimate MDD prevalence.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim. May combine two claims.

    Study design and conductnone given

    The DSM-5 severity specifier was defined by MDD symptom counts, which are straightforward, transparent, and replicable.

    “Furthermore, we defined the DSM-5 severity specifier by MDD symptom counts, which are straightforward, transparent, and replicable.”
    Quote in the paperSubstantial claim
48 of 48

  • The paper relies on this without support.

    National epidemiologic information on major depressive disorder is limited to pre-DSM-5 studies conducted more than 15 years ago.

    “However, national epidemiologic information on major depressive disorder (MDD) is limited to pre-DSM-5 studies conducted more than 15 years ago.”

  • The paper relies on this without support.

    The proportion of MDD cases diagnosed as positive after bereavement has not been studied.

    “the proportion of MDD cases diagnosed as positive after bereavement has also not been studied.”

  • The paper relies on this without support.

    DSM-IV and DSM-5 include a severity specifier (mild, moderate, or severe) that had not previously been examined in national data.

    “The DSM-IV and DSM-5 include a severity specifier (mild, moderate, or severe) not previously examined in national data.”

  • The paper relies on this without support.

    The DSM-5 does not state the number of MDD symptoms required for each severity level.

    “The DSM-5 does not state the number of MDD symptoms required for each severity level, so these levels were defined as follows: mild is 5 symptoms (minimum for a diagnosis), moderate is 6 to 7 symptoms, and severe is 8 to 9 symptoms.”

  • The paper relies on this without support.

    The DSM-5 states that distress and impairment should increase across severity levels but without clear definitions.

    “The DSM-5 also states that distress and impairment should increase across levels but without clear definitions.”

  • The paper relies on this without support.

    The DSM-5 suggests incorporation of distress and impairment levels into the severity classifications but defines these vaguely.

    “The DSM-5 also suggests incorporation of distress and impairment levels into the severity classifications but defines these vaguely.”
6 of 6

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • Half of women with infertility in LMICs experience lifetime abuse that culminates in anxiety and depressive episodes.

    “Half of the women with infertility in LMICs experience lifetime abuse that culminates in anxiety and depressive episodes [6,14,15].”

    From Psychosocial interventions for improving marital intimacy, sexual satisfaction, and quality of life of women and couples with infertility problems in low and middle-income countries: Systematic review protocol (2025) · cites this paper as [14]

    The Discussion suggests that greater depression prevalence among women may be related to adversities such as sexual abuse, and reports an association between major depressive disorder and anxiety disorders. It does not address women with infertility in LMICs, estimate that half experience lifetime abuse, or establish that abuse causes anxiety and depressive episodes. The Limitations section cautions that the study’s associations do not necessarily indicate causation. (LLM, conf=0.86)

    Experimental — accuracy not yet measured

  • Low socioeconomic status is a significant risk factor for MDD.

    “Although MDD is present in individuals of various social situations, it seems to increase considerably in poor populations and low socioeconomic status, suggesting that this condition is a significant risk factor for the disorder [7],[16],[17].”

    From Stress and serum cortisol levels in major depressive disorder: a cross-sectional study (2020) · cites this paper as [7]

    The DSM-5 MDD Prevalence and Sociodemographic Correlates section reports greater odds of 12-month MDD in lower household-income categories. The Discussion also identifies an association with low income, but acknowledges that depression-impaired functioning could lead to lower income. The paper therefore supports an association, not the stronger claim that low socioeconomic status is an established risk factor causing MDD. (LLM, conf=0.86)

    Experimental — accuracy not yet measured

  • MDD is highly comorbid with other mental and physical health conditions.

    “Given that MDD is highly comorbid with other mental and physical health conditions [7,43]”

    From The Economic Burden of Adults with Major Depressive Disorder in the United States (2019) (2023) · cites this paper as [7]

  • A multi-site fully remote e-clinical validation study that enrolled participants with MDD to evaluate the sensitivity and specificity of Kintsugi's technology's prediction has recently been completed.

    “A multi-site fully remote e-clinical validation study that enrolled participants with MDD to evaluate the sensitivity and specificity of Kintsugi's technology's prediction has recently been completed.”

    From Digital health technologies and major depressive disorder (2023) · cites this paper as [115]

  • Kintsugi is a passive vocal biomarker instrument that uses short clips of free-form speech for depression screening.

    “Kintsugi is a passive vocal biomarker instrument that uses short clips of free-form speech for depression screening.”

    From Digital health technologies and major depressive disorder (2023) · cites this paper as [115]

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • Reported median falls below its implied duration category

    Minor

    For participants whose MDD began in the past 12 months, 38.35% had a longest episode of 8 weeks or less, and 53.07% had one of 12 weeks or less. The median must therefore be in the 9-12-week category, not 8.81 weeks.

1 of 1

Cites

Flagged first, then by citations

7 of the 113 references couldn’t be matched to a known paper.

Research works printed but not linked: 12

  1. [8]8. Grant BF, Harford TC. Comorbidity between DSM-IV alcohol use disorders and major depression. Drug Alcohol Depend. 1995;39(3):197-206.
  2. [11]11. Vancampfort D, Mitchell AJ, De Hert M, et al. Type 2 diabetes in patients with major depressive disorder. Depress Anxiety. 2015;32(10):763-773.
  3. [13]13. Moussavi S, Chatterji S, Verdes E, Tandon A, Patel V, Ustun B. Depression, chronic diseases, and decrements in health. Lancet. 2007;370(9590): 851-858.
  4. [22]22. Targum SD, Suppes T, Pendergrass JC, et al. Major depressive disorder with subthreshold hypomania (mixed features). Prog Neuropsychopharmacol Biol Psychiatry. 2016; 68:9-14.
  5. [23]23. Goldberg JF, Ng-Mak D, Siu C, Chuang CC, Rajagopalan K, Loebel A. Remission and recovery associated with lurasidone in the treatment of major depressive disorder with subthreshold hypomanic symptoms (mixed features). CNS Spectr. 2017;22(2):220-227.
  6. [29]29. Hasin DS, Shmulewitz D, Stohl M, et al. Procedural validity of the AUDADIS-5 depression, anxiety and post-traumatic stress disorder modules. Drug Alcohol Depend. 2015;152:246-256.
  7. [50]50. McLaughlin KA, Conron KJ, Koenen KC, Gilman SE. Childhood adversity, adult stressful life events, and risk of past-year psychiatric disorder. Psychol Med. 2010;40(10):1647-1658.
  8. [53]53. Zorn JV, Schür RR, Boks MP, Kahn RS, Joëls M, Vinkers CH. Cortisol stress reactivity across psychiatric disorders. Psychoneuroendocrinology. 2017;77:25-36.
  9. [63]63. Compton WM, Han B, Jones CM, Blanco C, Hughes A. Marijuana use and use disorders in adults in the USA, 2002-14. Lancet Psychiatry. 2016;3(10): 954-964.
  10. [65]65. Pacek LR, Mauro PM, Martins SS. Perceived risk of regular cannabis use in the United States from 2002 to 2012. Drug Alcohol Depend. 2015; 149:232-244.
  11. [71]71. Corroon JM Jr, Mischley LK, Sexton M. Cannabis as a substitute for prescription drugs. J Pain Res. 2017;10:989-998.
  12. [86]86. Fahimi M, Link M, Mokdad A, Schwartz DA, Levy P. Tracking chronic disease and risk behavior prevalence as survey participation declines. Prev Chronic Dis. 2008;5(3):A80.

Cited by

Sorted by citations

Related

Authors
Hasin, D. S., Sarvet, A. L., Meyers, J. L., Saha, T. D., Ruan, W. J., Stohl, M., & Grant, B. F.
Affiliations
  • Columbia University Irving Medical Center (US)
  • SUNY Downstate Health Sciences University (US)
  • National Institutes of Health (US)
  • New York State Psychiatric Institute (US)
  • Fedpoint Systems, LLC, Arlington, Virginia
Corresponding author
Hasin, Deborah S.
ORCID
Venue
JAMA Psychiatry
Publisher
American Medical Association (AMA)
Published
2018-04-01
Volume
75
Issue
4
Pages
336
ISSN
2168-622X (ISSN-L)
DOI
10.1001/jamapsychiatry.2017.4602
PMC
PMC5875313
OpenAlex
W2789034326
Cited by
1,737
References
113
Citations by year
2026: 166 · 2025: 217 · 2024: 268 · 2023: 269 · 2022: 256 · 2021: 263 · 2020: 166 · 2019: 102 · 2018: 28
FWCI
189.63
Type
journal article
Language
en
Open access
Locations
  • JAMA Psychiatry (publishedVersion)
  • Europe PMC (PubMed Central) (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
Funders
  • National Institutes of Health
  • National Institute on Drug Abuse (K01DA037914)
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
major depressive disorder, DSM-5, prevalence, psychiatric comorbidity, bereavement, depressive symptoms, functional disability, antidepressant treatment, sex differences, racial and ethnic disparities, income, NESARC-III, United States adults, substance use disorders, anxiety disorders, mood disorders
MeSH terms
Correlation of Data, Adolescent, Adult, Age Factors, Anxiety Disorders, Cross-Sectional Studies, Major Depressive Disorder, Ethnicity, Female, Humans, Male, Sex Factors, Social Class, United States, Comorbidity, Diagnostic and Statistical Manual of Mental Disorders

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Claims read by deepseek-v4.1-flash under definition version 3 (extract-v3) on 2026-10-11.

Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-10-11.

Cited sources are checked by gpt-6-sol.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

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