The Costs of Depression
Open accessAbstract
Brief summary Data are reviewed on the societal costs of major depressive disorder (MDD). Early-onset MDD is found to predict difficulties in subsequent role transitions, including low educational attainment, high risk of teen child-bearing, marital disruption, and unstable employment. Among people with specific social and productive roles, MDD is found to predict significant decrements in role functioning (e.g., low marital quality, low work performance, low earnings). MDD is also associated with elevated risk of onset, persistence, and severity of a wide range of chronic physical disorders as well as with increased early mortality due to an even wider range of physical disorders and to suicide. Although effectiveness trials show that expanded MDD treatment can reverse many of these adverse effects, only a minority of people with MDD receives treatment and the quality of treatment is unacceptably low among the majority of those in treatment.
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- Premisecitation
Major depressive disorder is linked to higher risk of developing, sustaining, and experiencing severe forms of many chronic physical disorders.
“MDD is also associated with elevated risk of onset, persistence, and severity of a wide range of chronic physical disorders as well as with increased early mortality due to an even wider range of physical disorders and to suicide.”
Quote in the paperSubstantial claim0 of 10 sources checked- cites [86] Buist-Bouwman, 2005, Comorbidity of physical and mental disorders and the effect on work-loss days, Acta Psychiatr Scand source
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- cites [87] Chapman, 2005, The vital link between chronic disease and depressive disorders, Prev Chronic Dis
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- cites [88] Derogatis, 1983, The prevalence of psychiatric disorders among cancer patients, JAMA source
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- cites [89] Dew, 1998, Psychiatric disorder in the context of physical illness
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- cites [91] Nemeroff, 1998, Depression and cardiac disease, Depress Anxiety source
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- cites [92] Ortega, 2006, Co-occurrence of mental and physical illness in US Latinos, Soc Psychiatry Psychiatr Epidemiol source
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- cites [93] Wells, 1989, Chronic medical conditions in a sample of the general population with anxiety, affective, and substance use disorders, Am J Psychiatry source
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- cites [94] Scott, 2007, Depression-anxiety relationships with chronic physical conditions: results from the World Mental Health Surveys, J Affect Disord source
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- cites [104] Cohen, 1995, Pathways linking affective disturbances and physical disorders, Health Psychol source
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- Premisecitation
Early-onset major depressive disorder predicts later difficulties in role transitions, such as lower educational attainment, higher risk of teen childbearing, marital disruption, and unstable employment.
“Early-onset MDD is found to predict difficulties in subsequent role transitions, including low educational attainment, high risk of teen child-bearing, marital disruption, and unstable employment.”
Quote in the paperSubstantial claim0 of 10 sources checked- cites [19] Breslau, 2008, Mental disorders and subsequent educational attainment in a US national sample, J Psychiatr Res source
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- cites [20] Breslau, 2011, Childhood and adolescent onset psychiatric disorders, substance use, and failure to graduate high school on time, J Psychiatr Res source
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- cites [21] Kessler, 1995, Social consequences of psychiatric disorders, I: Educational attainment, Am J Psychiatry source
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- cites [22] Lee, 2009, Mental disorders and termination of education in high-income and low- and middle-income countries: epidemiological study, Br J Psychiatry source
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- cites [23] McLeod, 2004, Childhood emotional and behavioral problems and educational attainment, Am Sociological Rev source
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- cites [24] Porche, 2011, Childhood trauma and psychiatric disorders as correlates of school dropout in a national sample of young adults, Child Dev source
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- cites [25] Vaughn, 2011, Psychiatric correlates of behavioral indicators of school disengagement in the United States, Psychiatr Q source
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- cites [26] Woodward, 2001, Life course outcomes of young people with anxiety disorders in adolescence, J Am Acad Child Adolesc Psychiatry source
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- cites [27] Breslau, 2011, A multinational study of mental disorders, marriage, and divorce, Acta Psychiatr Scand source
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- cites [28] Forthofer, 1996, The effects of psychiatric disorders on the probability and timing of first marriage, J Health Soc Behav source
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- Premisecitation
Among people occupying social and productive roles, major depressive disorder predicts substantial declines in role functioning, including poorer marital quality, lower work performance, and lower earnings.
“Among people with specific social and productive roles, MDD is found to predict significant decrements in role functioning (e.g., low marital quality, low work performance, low earnings).”
Quote in the paperSubstantial claim0 of 10 sources checked- cites [41] Kronmuller, 2011, Quality of marital relationship and depression: results of a 10-year prospective follow-up study, J Affect Disord source
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- cites [42] Pearson, 2010, The psychosocial context of depressive rumination: ruminative brooding predicts diminished relationship satisfaction in individuals with a history of past major depression, Br J Clin Psychol source
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- cites [43] Stith, 2004, Intimate partner physical abuse perpetration and victimization risk factors: A meta-analytic review, Aggress Viol Behav source
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- cites [64] Kessler, 2006, Prevalence and effects of mood disorders on work performance in a nationally representative sample of U.S. workers, Am J Psychiatry source
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- cites [65] Stewart, 2003, Cost of lost productive work time among US workers with depression, JAMA source
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- cites [66] Wang, 2003, The economic burden of depression and the cost-effectiveness of treatment, Int J Methods Psychiatr Res source
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- cites [67] Ford, 2010, Common mental disorders, unemployment and welfare benefits in England, Public Health source
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- cites [68] Insel, 2008, Assessing the economic costs of serious mental illness, Am J Psychiatry source
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- cites [69] Kessler, 2008, Individual and societal effects of mental disorders on earnings in the United States: results from the national comorbidity survey replication, Am J Psychiatry source
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- cites [70] Levinson, 2010, Associations of serious mental illness with earnings: results from the WHO World Mental Health surveys, Br J Psychiatry source
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- Premisecitation
Bipolar depression is considerably more persistent than non-bipolar depression.
“bipolar depression is considerably more persistent than non-bipolar depression,5”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [5] Merikangas, 2011, Prevalence and correlates of bipolar spectrum disorder in the World Mental Health Survey Initiative, Arch Gen Psychiatry source
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- Premisecitation
Expanded treatment for major depressive disorder can reverse many of its adverse effects.
“Although effectiveness trials show that expanded MDD treatment can reverse many of these adverse effects, only a minority of people with MDD receives treatment and the quality of treatment is unacceptably low among the majority of those in treatment.”
Quote in the paperSubstantial claim0 of 2 sources checked- cites [129] Wang, 2007, Telephone screening, outreach, and care management for depressed workers and impact on clinical and work productivity outcomes: a randomized controlled trial, JAMA source
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- cites [130] Rost, 2011, Depression care management: can employers purchase improved outcomes?, Depress Res Treat
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- Premisecitation
Only a minority of people with major depressive disorder receive treatment.
“Although effectiveness trials show that expanded MDD treatment can reverse many of these adverse effects, only a minority of people with MDD receives treatment and the quality of treatment is unacceptably low among the majority of those in treatment.”
Quote in the paperSubstantial claim0 of 2 sources checked- cites [132] Birnbaum, 2010, Employer burden of mild, moderate, and severe major depressive disorder: mental health services utilization and costs, and work performance, Depress Anxiety source
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- cites [134] Katon, 2007, The association of depression and anxiety with medical symptom burden in patients with chronic medical illness, Gen Hosp Psychiatry source
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- Interpretationreasoning
The community survey finding that lifetime prevalence is two to three times 12-month prevalence suggests that between one third and one half of lifetime cases have recurrent episodes in a given year.
“The community survey finding that lifetime prevalence is two-three times that of 12-month prevalence suggests that between a third and a half of lifetime cases have recurrent episodes in a given year.”
Quote in the paperNot a substantial claim - Interpretationreasoning
The share of major depressive episode cases attributable to bipolar depression rises as the assessment period shortens.
“the proportion of MDE cases due to bipolar depression increases as the time frame of assessment decreases”
Quote in the paperSubstantial claim - Premisecitation
The quality of treatment for major depressive disorder is low for most people who receive it.
“Although effectiveness trials show that expanded MDD treatment can reverse many of these adverse effects, only a minority of people with MDD receives treatment and the quality of treatment is unacceptably low among the majority of those in treatment.”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [132] Birnbaum, 2010, Employer burden of mild, moderate, and severe major depressive disorder: mental health services utilization and costs, and work performance, Depress Anxiety source
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- Premisecitation
Clinical studies indicate that a substantial proportion of people who seek treatment for major depression have a chronic-recurrent course.
“clinical studies show that a substantial proportion of people who seek treatment for major depression have a chronic-recurrent course of illness.13, 14”
Quote in the paperNot a substantial claim0 of 2 sources checked- cites [13] Hardeveld, 2010, Prevalence and predictors of recurrence of major depressive disorder in the adult population, Acta Psychiatr Scand source
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- cites [14] Torpey, 2008, Chronic depression: update on classification and treatment, Curr Psychiatry Rep source
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- Premisecitation
Long-term longitudinal studies show that some people with lifetime major depressive disorder do not report their depression history in cross-sectional studies.
“long-term longitudinal studies also show that some people with lifetime MDD fail to report their history of depression in cross-section studies.16, 17”
Quote in the paperSubstantial claim0 of 2 sources checked - Interpretationreasoning
There is good reason to believe that major depressive disorder might be a causal risk factor for at least some chronic physical disorders.
“Based on these observations, there is good reason to believe that MDD might be a causal risk factor for at least some chronic physical disorders.”
Quote in the paperSubstantial claim - Interpretationcitation
Available evidence suggests that expanded treatment could be of considerable value for patients with chronic physical disorders.
“Less information is available on rates of depression treatment among patients with chronic physical disorders, but available evidence suggests that expanded treatment could be of considerable value.135”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [135]
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- Rests on an assumption: Less information is available on rates of depression treatment among patients with chronic physical disorders.
- May combine two claims. 29
- Classified as probably not a substantial claim. 2
- The quote only partly states this claim. 1
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Findingown dataIn the WMH data, neither the expectation that countries with the lowest prevalence would have the most severe cases nor the expectation that core depressive symptoms would be more similar across countries than disorder prevalence was supported.
“Neither of these expectations was borne out, though, when they were examined in the WMH data, adding indirect support to a substantive interpretation of the cross-national differences in MDE.”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [10] Bromet, 2011, Cross-national epidemiology of DSM-IV major depressive episode, BMC Med source
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Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.
PremisecitationThe World Health Organization ranks major depressive disorder as the fourth leading cause of disability globally and projects it will become the second leading cause by 2020 because of rising prevalence in recent cohorts.
“The World Health Organization ranks major depressive disorder (MDD) as the 4th leading cause of disability worldwide3 and projects that by 2020 it will be the second leading cause due to currently unexplained increasing prevalence in recent cohorts.4”
Quote in the paperNot a substantial claim0 of 2 sources checked- cites [3] Murray, 1996, Evidence-based health policy—lessons from the Global Burden of Disease Study, Science source
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- cites [4] Murray, 1996, The Global Burden of Disease: a comprehensive assessment of mortality and disability from diseases, injuries and risk factors in 1990 and projected to 2020, Harvard University Press
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PremisecitationMajor depressive disorder and several other early-onset mental disorders significantly predict increased teen childbearing, and the overall associations are due to increased sexual activity rather than decreased contraceptive use.
“MDD and a number of other early-onset mental disorders were significant predictors of increased teen childbearing. Disaggregation found that the overall associations were due to disorders predicting increased sexual activity but not decreased use of contraception.”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [32] Kessler, 1997, Social consequences of psychiatric disorders, II: Teenage parenthood, Am J Psychiatry source
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PremisecitationMajor depression is a frequently occurring, severely disabling, and often recurring mental disorder.
“Major depression is a commonly occurring, seriously impairing, and often recurrent mental disorder.1, 2”
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PremisecitationPre-marital history of mental disorders predicts divorce, with associations quite similar for husbands and wives across all countries, and major depressive disorder is among the most important disorders in this regard.
“A separate set of studies has shown that pre-marital history of mental disorders predicts divorce,30, 31 again with associations quite similar for husbands and wives across all countries and MDD among the most important disorders in this regard.27”
Quote in the paperSubstantial claim0 of 3 sources checked- cites [30] Butterworth, 2008, Mental health problems and marital disruption: is it the combination of husbands and wives' mental health problems that predicts later divorce?, Soc Psychiatry Psychiatr Epidemiol source
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- cites [31] Kessler, 1998, The social consequences of psychiatric disorders, III: probability of marital stability, Am J Psychiatry source
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- cites [27] Breslau, 2011, A multinational study of mental disorders, marriage, and divorce, Acta Psychiatr Scand source
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PremisecitationCross-national surveys found lifetime major depressive disorder prevalence between 1.5% and 19.0% (midpoint 9.4%) and 12-month prevalence between 0.8% and 5.8% (midpoint 3.7%), with generally higher rates in high-income than lower-income countries.
“Lifetime prevalence estimates in these surveys were in the range 1.5–19.0%, with a midpoint of 9.4% and generally higher rates in high income than lower income countries. Twelve-month prevalence estimates were in the range 0.8-5.8%, with a midpoint of 3.7%.”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [6] Weissman, 1996, Cross-national epidemiology of major depression and bipolar disorder, JAMA source
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PremisecitationDepression is known to be associated with unemployment, but most research has emphasized job loss causing depression rather than depression causing job loss; history of mental disorders as of completing schooling predicts current unemployment and work disability, but only in high-income countries, raising the possibility that major depressive disorder becomes more detrimental as work complexityin
“Although depression is known to be associated with unemployment, most research on this association has emphasized the impact of job loss on depression rather than depression as a risk factor for job loss.33 A recent analysis from the WMH surveys documented the latter association by showing that history of mental disorders as of the age of completing schooling predicted current (at the time of”
Quote in the paperSubstantial claim0 of 2 sources checkedMay combine two claims.
PremisecitationIn the WHO World Health Survey, the 12-month prevalence of major depressive episode was 3.2% overall and between 9.3% and 23.0% among respondents with a chronic condition.
“The 12-month prevalence of major depression was 3.2% and between 9.3% and 23.0% among participants with a chronic condition.”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [9] Moussavi, 2007, Depression, chronic diseases, and decrements in health: results from the World Health Surveys, Lancet source
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PremisecitationEarly-onset mental disorders are associated with ending education, with disruptive behavior disorders and bipolar disorder showing the strongest associations, and major depressive disorder associated with roughly 60% higher odds of failing to complete secondary school in high-income countries.
“Several studies show early-onset mental disorders associated termination of education.19–26 While disruptive behavior disorders and bipolar disorder tend to have the strongest associations in these studies, MDD also is significantly associated with a roughly 60% elevated odds of failure to complete secondary school than otherwise comparable youth in high income countries.”
Quote in the paperSubstantial claim0 of 8 sources checked- cites [19] Breslau, 2008, Mental disorders and subsequent educational attainment in a US national sample, J Psychiatr Res source
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- cites [20] Breslau, 2011, Childhood and adolescent onset psychiatric disorders, substance use, and failure to graduate high school on time, J Psychiatr Res source
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- cites [21] Kessler, 1995, Social consequences of psychiatric disorders, I: Educational attainment, Am J Psychiatry source
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- cites [22] Lee, 2009, Mental disorders and termination of education in high-income and low- and middle-income countries: epidemiological study, Br J Psychiatry source
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- cites [23] McLeod, 2004, Childhood emotional and behavioral problems and educational attainment, Am Sociological Rev source
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- cites [24] Porche, 2011, Childhood trauma and psychiatric disorders as correlates of school dropout in a national sample of young adults, Child Dev source
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- cites [25] Vaughn, 2011, Psychiatric correlates of behavioral indicators of school disengagement in the United States, Psychiatr Q source
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- cites [26] Woodward, 2001, Life course outcomes of young people with anxiety disorders in adolescence, J Am Acad Child Adolesc Psychiatry source
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May combine two claims.
PremisecitationMajor depressive disorder is associated with higher risk of early death from a broad set of physical disorders and from suicide.
“MDD is also associated with elevated risk of onset, persistence, and severity of a wide range of chronic physical disorders as well as with increased early mortality due to an even wider range of physical disorders and to suicide.”
Quote in the paperSubstantial claim0 of 6 sources checked- cites [104] Cohen, 1995, Pathways linking affective disturbances and physical disorders, Health Psychol source
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- cites [106] Katon, 2002, Impact of major depression on chronic medical illness, J Psychosom Res source
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- cites [119] Bostwick, 2000, Affective disorders and suicide risk: a reexamination, Am J Psychiatry source
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- cites [120] Moller, 2003, Suicide, suicidality and suicide prevention in affective disorders, Acta Psychiatr Scand Suppl source
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- cites [121] Rihmer, 2007, Suicide risk in mood disorders, Curr Opin Psychiatry source
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- cites [122] Barth, 2004, Depression as a risk factor for mortality in patients with coronary heart disease: a meta-analysis, Psychosom Med source
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PremisecitationIn the 18-country WHO World Mental Health Surveys, mean lifetime and 12-month prevalence of DSM-IV major depressive episode were 14.6% and 5.5% in high-income countries versus 11.1% and 5.9% in low-middle-income countries.
“Mean lifetime and 12-month prevalence estimates of DSM-IV MDE were 14.6% and 5.5% in high income countries compared to 11.1% and 5.9% in low-middle income countries.”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [10] Bromet, 2011, Cross-national epidemiology of DSM-IV major depressive episode, BMC Med source
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PremisecitationLater WHO cross-national studies found major depressive disorder prevalence estimates very similar to earlier ECA-based surveys, again with higher rates in high-income countries.
“Subsequent studies8 using a diagnostic interview developed by the World Health Organization (WHO) explicitly for cross-national comparative research found prevalence estimates of MDD that were very similar to those in the earlier ECA-based surveys, again finding higher rates in high income than lower income countries.8”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [8] Andrade, 2003, The epidemiology of major depressive episodes: results from the International Consortium of Psychiatric Epidemiology (ICPE) Surveys, Int J Methods Psychiatr Res source
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PremisecitationBoth perpetration of and victimization by physical violence in marital relationships are significantly associated with depression; longitudinal studies find pre-marital mental disorders predict subsequent marital violence perpetration and victimization, but few studies adjusted for comorbidity, and in the WMH surveys the association between premarital major depressive disorder and marital violence
“Considerable research documents that both perpetration of and victimization by physical violence in marital relationships are significantly associated with depression.44 While these studies have generally focused on presumed mental health consequences of relationship violence,45–47 a growing body of research has more recently suggested that marital violence is partly a consequence of pre-existing”
Quote in the paperSubstantial claim0 of 6 sources checked- cites [44] Afifi, 2009, Mental health correlates of intimate partner violence in marital relationships in a nationally representative sample of males and females, J Interpers Violence source
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- cites [48] Lorber, 2004, Predictors of the persistence of male aggression in early marriage, J Fam Viol source
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- cites [49] O'Leary, 2008, Descriptive epidemiology of intimate partner aggression in Ukraine, Soc Psychiatry Psychiatr Epidemiol source
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- cites [50] Riggs, 2000, Risk for domestic violence: factors associated with perpetration and victimization, J Clin Psychol source
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- cites [51] Fang, 2010, Attention-deficit/hyperactivity disorder, conduct disorder, and young adult intimate partner violence, Arch Gen Psychiatry source
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- cites [54] Lovejoy, 2000, Maternal depression and parenting behavior: a meta-analytic review, Clin Psychol Rev source
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InterpretationreasoningBecause recall failure in retrospective reports of lifetime prevalence is likely, the WMH 12-month-to-lifetime prevalence ratios are upper-bound estimates of persistence and WMH lifetime prevalence estimates are lower-bound estimates of true lifetime prevalence.
“it would nonetheless be prudent to consider the 12-month-to-lifetime prevalence ratios in the WMH surveys upper-bound estimates on persistence and WMH lifetime prevalence estimates lower-bound estimates on true lifetime prevalence because of likely recall failure in retrospective reports of lifetime prevalence.”
Quote in the paperNot a substantial claimMay combine two claims.
PremisecitationBoth maternal and paternal depression are significantly associated with negative parenting behaviors, most pronounced for parents of young children, and parent depression leads to maladaptive parent-infant interactions that impede infant affect regulation and later child development.
“A number of studies have documented significant associations of both maternal55 and paternal56 depression with negative parenting behaviors. These associations are found throughout the age range of children, but most pronounced for the parents of young children. Although only an incomplete understanding exists of pathways, both laboratory and naturalistic studies of parent-infant micro-interact”
Quote in the paperSubstantial claim0 of 3 sources checked- cites [55] Wilson, 2010, Effects of paternal depression on fathers' parenting behaviors: a meta-analytic review, Clin Psychol Rev source
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- cites [56] Tronick, 2009, Infants of depressed mothers, Harv Rev Psychiatry source
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- cites [57] Alonso, 2004, Disability and quality of life impact of mental disorders in Europe: results from the European Study of the Epidemiology of Mental Disorders (ESEMeD) project, Acta Psychiatr Scand Suppl
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PremisecitationChronic depression subtypes are poorly understood.
“chronic depression subtypes are poorly understood. 15”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [15] Benazzi, 2006, Various forms of depression, Dialogues Clin Neurosci source
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PremisecitationEarly-onset mental disorders predict a lower probability of ever marrying, are either positively associated or unrelated with marriage before age 18, and are negatively associated with on-time and late marriage; these patterns are largely similar for men and women and across countries, and major depressive disorder is one of the most important pre-marital mental disorders.
“Early-onset mental disorders predict low probability of ever marrying, but are either positively associated28 or unrelated27 with early (before age 18) marriage, which is known to be associated with a number of adverse outcomes, and negatively associated with on-time and late marriage, which are known to be associated with a number of benefits (e.g., financial security, social support). These ass”
Quote in the paperSubstantial claim0 of 3 sources checked- cites [27] Breslau, 2011, A multinational study of mental disorders, marriage, and divorce, Acta Psychiatr Scand source
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- cites [28] Forthofer, 1996, The effects of psychiatric disorders on the probability and timing of first marriage, J Health Soc Behav source
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- cites [29] Whisman, 2007, Social consequences of personality disorders: probability and timing of marriage and probability of marital disruption, J Pers Disord source
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PremisecitationMarital dissatisfaction and discord are strongly related to depressive symptoms, with an average correlation of about r = .4 across studies and very similar patterns for men and women; the association is bidirectional, but marital discord predicts later depressive symptoms more strongly than the reverse; clinical depression has significant adverse effects on marital functioning.
“It has long been known that marital dissatisfaction and discord are strongly related to depressive symptoms (e.g.,35, 36), with an average correlation between marital dissatisfaction and depressive symptoms of approximately r = .4 across studies and very similar patterns for men and women.37 Longitudinal studies show that the association is bidirectional,38, 39 but with a stronger time-lagged”
Quote in the paperSubstantial claim0 of 5 sources checked- cites [35] Whisman, 1999, Marital dissatisfaction and psychiatric disorders: results from the National Comorbidity Survey, J Abnorm Psychol source
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- cites [36] Whisman, 2001, The association between depression and marital dissatisfaction
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- cites [37] Mamun, 2009, Maternal depression and the quality of marital relationship: a 14-year prospective study, J Womens Health (Larchmt) source
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- cites [38] Whisman, 2009, Prospective associations between marital discord and depressive symptoms in middle-aged and older adults, Psychol Aging source
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- cites [39] Proulx, 2007, Marital quality and personal well-being: a meta-analysis, J Marriage Fam source
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PremisecitationMajor depressive disorder is associated with significantly elevated risk of early death, partly due to high suicide risk and partly due to elevated risk of many physical disorders; it is also associated with elevated mortality risk among people with certain disorders as part of a larger pattern of associations with disorder severity.
“MDD is associated with significantly elevated risk of early death.104, 106, 119 This is true partly because people with MDD have high suicide risk,120–122 but also because depression is associated with elevated risk of the many types of disorders noted above. MDD is also associated with elevated mortality risk among people with certain kinds of disorders as part of a larger pattern of associations”
Quote in the paperSubstantial claim0 of 6 sources checked- cites [104] Cohen, 1995, Pathways linking affective disturbances and physical disorders, Health Psychol source
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- cites [106] Katon, 2002, Impact of major depression on chronic medical illness, J Psychosom Res source
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- cites [119] Bostwick, 2000, Affective disorders and suicide risk: a reexamination, Am J Psychiatry source
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- cites [120] Moller, 2003, Suicide, suicidality and suicide prevention in affective disorders, Acta Psychiatr Scand Suppl source
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- cites [121] Rihmer, 2007, Suicide risk in mood disorders, Curr Opin Psychiatry source
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- cites [122] Barth, 2004, Depression as a risk factor for mortality in patients with coronary heart disease: a meta-analysis, Psychosom Med source
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May combine two claims.
PremisecitationMajor depressive disorder is associated with a larger decrement in perceived health than angina, arthritis, asthma, and diabetes across countries and socio-demographic subgroups; in the WMH surveys, major depressive disorder was one of the three disorders associated with the highest decrements in perceived health, along with severe insomnia and neurological disorders.
“A consistent pattern was found in these surveys across countries and socio-demographic subgroups within countries for MDD to be associated with a larger decrement in perceived health than any of the four physical disorders compared with it (angina, arthritis, asthma, diabetes). The second study was part of the WMH surveys, where MDD was compared with 18 other physical (e.g., cancer, cardiovascula”
Quote in the paperSubstantial claim0 of 2 sources checked- cites [9] Moussavi, 2007, Depression, chronic diseases, and decrements in health: results from the World Health Surveys, Lancet source
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- cites [85] Anderson, 2001, The prevalence of comorbid depression in adults with diabetes: a meta-analysis, Diabetes Care source
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PremisecitationTwo large-scale randomized workplace depression treatment effectiveness trials in the US evaluated cost-effectiveness from an employer perspective and both had positive returns-on-investment to employers; a substantial expansion of worksite depression care management programs occurred in the US after publication.
“Two separate large-scale randomized workplace depression treatment effectiveness trials have been carried out in the US to evaluate the cost-effectiveness of expanded treatment from an employer perspective.129, 130 Both trials had positive returns-on-investment to employers. A substantial expansion of worksite depression care management programs has occurred in the US subsequent to the publication”
Quote in the paperNot a substantial claim0 of 3 sources checked- cites [129] Wang, 2007, Telephone screening, outreach, and care management for depressed workers and impact on clinical and work productivity outcomes: a randomized controlled trial, JAMA source
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- cites [130] Rost, 2011, Depression care management: can employers purchase improved outcomes?, Depress Res Treat
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- cites [131] Kessler, 2008, The prevalence and correlates of workplace depression in the national comorbidity survey replication, J Occup Environ Med source
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PremisecitationMajor depressive disorder is a consistent predictor of the subsequent first onset of coronary artery disease, stroke, diabetes, heart attacks, and certain types of cancer, though evidence about major depressive disorder as a cause of physical disorders is spotty.
“we know from meta-analyses of longitudinal studies that MDD is a consistent predictor of the subsequent first onset of coronary artery disease,97, 98 stroke,99 diabetes,100 heart attacks ,101, 102 and certain types of cancer.103”
Quote in the paperSubstantial claim0 of 7 sources checked- cites [97] Wulsin, 2003, Do depressive symptoms increase the risk for the onset of coronary disease?, Psychosom Med source
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- cites [98] Ohira, 2001, Prospective study of depressive symptoms and risk of stroke among Japanese, Stroke source
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- cites [99] Carnethon, 2003, Symptoms of depression as a risk factor for incident diabetes: findings from the National Health and Nutrition Examination Epidemiologic Follow-up Study, 1971-1992, Am J Epidemiol source
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- cites [100] Pratt, 1996, Depression, psychotropic medication, and risk of myocardial infarction, Circulation source
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- cites [101] Scherrer, 2009, Depression increases risk of incident myocardial infarction among Veterans Administration patients with rheumatoid arthritis, Gen Hosp Psychiatry source
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- cites [102] Gross, 2010, Depression and cancer risk: 24 years of follow-up of the Baltimore Epidemiologic Catchment Area sample, Cancer Causes Control source
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- cites [103] Carney, 2002, Depression as a risk factor for cardiac mortality and morbidity: a review of potential mechanisms, J Psychosom Res source
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May combine two claims. The quote only partly states this claim.
PremisecitationMusculoskeletal disorders and major depressive episode are associated with the highest levels of disability at the individual level among commonly occurring disorders; major depressive disorder and bipolar disorder are the mental disorders most often rated severely impairing in both developed and developing countries; none of the physical disorders considered had impairment levels as high as major
“MDE was included in a number of these studies and the results typically showed that musculoskeletal disorders and MDE were associated with the highest levels of disability at the individual level among all commonly occurring disorders assessed. The most compelling study of this sort outside the US was based on fifteen national surveys carried out as part of the WMH surveys.82 Disorder-specific dis”
Quote in the paperSubstantial claim0 of 7 sources checked- cites [59] Collins, 2005, The assessment of chronic health conditions on work performance, absence, and total economic impact for employers, J Occup Environ Med source
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- cites [62] Alonso, 2010, Days out of role due to common physical and mental conditions: results from the WHO World Mental Health surveys, Mol Psychiatry source
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- cites [78] Lerner, 2005, Work disability resulting from chronic health conditions, J Occup Environ Med source
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- cites [79] Stewart, 2003, Lost productive work time costs from health conditions in the United States: results from the American Productivity Audit, J Occup Environ Med source
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- cites [80] Verbrugge, 1995, Seven chronic conditions: their impact on US adults' activity levels and use of medical services, Am J Public Health source
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- cites [81] Ormel, 2008, Disability and treatment of specific mental and physical disorders across the world, Br J Psychiatry source
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InterpretationreasoningAlthough evidence is not definitive that major depressive disorder plays a causal role in its associations with many adverse outcomes, there is clear evidence that depression has causal effects on a number of important mediators, making it difficult to assume anything other than that depression has strong causal effects on many dimensions of burden.
“Although evidence is not definitive that MDD plays a causal role in its associations with the many adverse outcomes reviewed here, there is clear evidence that depression has causal effects on a number of important mediators, making it difficult to assume anything other than that depression has strong causal effects on many dimensions of burden.”
Quote in the paperSubstantial claimMay combine two claims.
PremisecitationMajor depressive disorder is associated with among the highest number of days out of role at the societal level of any physical or mental disorder; in the WMH surveys, it accounted for 5.1% of all days out of role, the fourth highest population attributable risk proportion and by far the largest among mental disorders.
“These studies typically find that MDD is associated with among the highest number of days out of role at the societal level of any physical or mental disorder due to its combination of comparatively high prevalence and comparatively strong individual-level association.60–62 In the WMH surveys, for example, 62,971 respondents across 24 countries were assessed for a wide range of common physical and”
Quote in the paperNot a substantial claim0 of 4 sources checked- cites [60] Munce, 2007, The role of depression and chronic pain conditions in absenteeism: results from a national epidemiologic survey, J Occup Environ Med source
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- cites [61] Wang, 2003, Chronic medical conditions and work performance in the health and work performance questionnaire calibration surveys, J Occup Environ Med source
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- cites [62] Alonso, 2010, Days out of role due to common physical and mental conditions: results from the WHO World Mental Health surveys, Mol Psychiatry source
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- cites [63] Greenberg, 2003, The economic burden of depression in the United States: how did it change between 1990 and 2000?, J Clin Psychiatry source
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PremisecitationPersonal earnings and household income of people with major depressive disorder are substantially lower than those without depression, but it is unclear whether depression is primarily a cause, consequence, or both because of reciprocal causation; previous studies have not controlled for reciprocal effects, making the size of adverse effects uncertain; childhood-adolescence depression predicts
“One of most striking aspects of the impairment associated with MDD is that the personal earnings and household income of people with MDD are substantially lower than those of people without depression.68–73 However, it is unclear whether depression is primariry a cause, consequence, or both in these associations due to the possibility of reciprocal causation between income-earnings and MDD.74”
Quote in the paperSubstantial claim0 of 7 sources checked- cites [68] Insel, 2008, Assessing the economic costs of serious mental illness, Am J Psychiatry source
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- cites [69] Kessler, 2008, Individual and societal effects of mental disorders on earnings in the United States: results from the national comorbidity survey replication, Am J Psychiatry source
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- cites [70] Levinson, 2010, Associations of serious mental illness with earnings: results from the WHO World Mental Health surveys, Br J Psychiatry source
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- cites [71] Marcotte, 2001, Estimating the employment and earnings costs of mental illness: recent developments in the United States, Soc Sci Med source
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- cites [72] McMillan, 2010, The association between income and distress, mental disorders, and suicidal ideation and attempts: findings from the collaborative psychiatric epidemiology surveys, J Clin Psychiatry source
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- cites [73] Muntaner, 2004, Socioeconomic position and major mental disorders, Epidemiol Rev source
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- cites [74] Jones, 1991, The health consequences of economic recessions, J Health Soc Policy source
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Interpretationown dataThe reviewed data show clearly that major depression is a commonly occurring and burdensome disorder, and the high prevalence, early onset, and high persistence of major depressive disorder across countries confirm its high worldwide importance.
“The data reported here show clearly that major depression is a commonly occurring and burdensome disorder. The high prevalence, early age of onset, and high persistence of MDD in the many different countries where epidemiological surveys have been administered confirm the high worldwide importance of depression.”
Quote in the paperSubstantial claimMay combine two claims.
PremisecitationMajor depressive disorder is significantly associated with a wide variety of chronic physical disorders, including arthritis, asthma, cancer, cardiovascular disease, diabetes, hypertension, chronic respiratory disorders, and chronic pain conditions; similar data exist from community surveys worldwide.
“It is now well established that MDD is significantly associated with a wide variety of chronic physical disorders, including arthritis, asthma, cancer, cardiovascular disease, diabetes, hypertension, chronic respiratory disorders, and a variety of chronic pain conditions.86–94 Although most of the data documenting these associations comes from clinical samples in the US, similar data also exist”
Quote in the paperSubstantial claim0 of 10 sources checked- cites [86] Buist-Bouwman, 2005, Comorbidity of physical and mental disorders and the effect on work-loss days, Acta Psychiatr Scand source
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- cites [87] Chapman, 2005, The vital link between chronic disease and depressive disorders, Prev Chronic Dis
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- cites [88] Derogatis, 1983, The prevalence of psychiatric disorders among cancer patients, JAMA source
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- cites [89] Dew, 1998, Psychiatric disorder in the context of physical illness
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- cites [91] Nemeroff, 1998, Depression and cardiac disease, Depress Anxiety source
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- cites [92] Ortega, 2006, Co-occurrence of mental and physical illness in US Latinos, Soc Psychiatry Psychiatr Epidemiol source
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- cites [93] Wells, 1989, Chronic medical conditions in a sample of the general population with anxiety, affective, and substance use disorders, Am J Psychiatry source
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- cites [94] Scott, 2007, Depression-anxiety relationships with chronic physical conditions: results from the World Mental Health Surveys, J Affect Disord source
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- cites [95] Von Korff, 2009
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PremisecitationMajor depressive episode and major depressive disorder significantly predict overall lost work performance, with annual salary-equivalent human capital value estimates between $30.1 billion and $51.5 billion.
“All these studies found that MDE and MDD significantly predict overall lost work performance. Several studies attempted to estimate the annual salary-equivalent human capital value of these losses. These estimates were in the range $30.1 billion66 to $51.5 billion.64”
Quote in the paperSubstantial claim0 of 4 sources checked- cites [64] Kessler, 2006, Prevalence and effects of mood disorders on work performance in a nationally representative sample of U.S. workers, Am J Psychiatry source
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- cites [65] Stewart, 2003, Cost of lost productive work time among US workers with depression, JAMA source
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- cites [67] Ford, 2010, Common mental disorders, unemployment and welfare benefits in England, Public Health source
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PremisecitationComorbid depression is often associated with a worse course of physical disorders, partly because depression is often associated with non-adherence to treatment regimens.
“comorbid depression is often associated with a worse course of the physical disorder.114–116 A number of reasons could be involved here, but one of the most consistently documented is that depression is often associated with non-adherence to treatment regimens.112, 117, 118”
Quote in the paperSubstantial claim0 of 6 sources checked- cites [114] Mancuso, 2001, Self-efficacy, depressive symptoms, and patients' expectations predict outcomes in asthma, Med Care source
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- cites [115] Peyrot, 1997, Levels and risks of depression and anxiety symptomatology among diabetic adults, Diabetes Care source
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- cites [116] Breitbart, 2000, Depression, hopelessness, and desire for hastened death in terminally ill patients with cancer, JAMA source
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- cites [112] Kiecolt-Glaser, 2002, Depression and immune function: central pathways to morbidity and mortality, J Psychosom Res source
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- cites [117] Cluley, 2001, Psychological disorder in asthma is associated with poor control and poor adherence to inhaled steroids, Respir Med source
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- cites [118] Wulsin, 1999, A systematic review of the mortality of depression, Psychosom Med source
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The paper relies on this without support.
Data on the prevalence and costs of major depressive disorder are unavailable for most countries.
“Although data on the prevalence and costs of MDD do not exist for most countries, psychiatric epidemiological surveys of the general population, students, and primary care patients have been carried out in many developed countries as well as in an increasing number of developing countries.”
The paper relies on this without support.
The vast majority of lifetime major depressive episodes are major depressive disorder.
“As the vast majority of lifetime MDE is MDD, the difference between the two is not of great importance when examining lifetime disorders.”
The paper relies on this without support.
Less information is available on rates of depression treatment among patients with chronic physical disorders.
“Less information is available on rates of depression treatment among patients with chronic physical disorders, but available evidence suggests that expanded treatment could be of considerable value.135”
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?
In Hawaiian secondary students, self-reported depressive symptoms resulted in subsequent poor academic achievement.
“A longitudinal study of Hawaiian secondary school students showed that self-reported depressive symptoms resulted in subsequent poor academic achievement (Kessler, 2012;McArdle, Hamagami, Chang, & Hishinuma, 2014).”
From The impact of stress on students in secondary school and higher education (2020) · cites this paper as Kessler, 2012
The Education subsection (page unavailable in our copy) reports that early-onset major depression is associated with increased odds of not completing secondary school. It does not describe a longitudinal study of Hawaiian students, self-reported symptoms, or subsequent academic achievement, and its association does not establish that symptoms caused poor achievement. (LLM, conf=0.86)
Experimental — accuracy not yet measuredPoor mental health in adolescence increases the risk of poor educational attainment, non-participation in postsecondary education, unemployment, low income when working, and being a recipient of welfare payments.
“Poor mental health in adolescence increases the risk of poor educational attainment, 24 and non-participation in postsecondary education, unemployment, low income when working, and being a recipient of welfare payments.”
From The Lancet Psychiatry Commission on youth mental health (2024) · cites this paper as [405]
Subclinical depression is associated with substantial functional impairment, including poor work performance.
“Subclinical depression is associated with substantial functional impairment, including poor work performance [3,7-9].”
From MoodHacker Mobile Web App With Email for Adults to Self-Manage Mild-to-Moderate Depression: Randomized Controlled Trial (2016) · cites this paper as [3]
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- Authors
- Kessler, R. C.
- Affiliations
- Harvard University (US)
- Corresponding author
- Kessler, Ronald C.
- ORCID
- Kessler, Ronald C.
- Venue
- Psychiatric Clinics of North America
- Publisher
- Elsevier BV
- Published
- 2012-03
- Volume
- 35
- Issue
- 1
- Pages
- 1-14
- ISSN
- 0193-953X (ISSN-L)
- PMC
- PMC3292769
- OpenAlex
- W2046186483
- Semantic Scholar
- 66931793f8460fc098253a009869cb09ab5d8054
- Cited by
- 871
- References
- 151
- Citations by year
- 2026: 29 · 2025: 57 · 2024: 60 · 2023: 86 · 2022: 92 · 2021: 79 · 2020: 91 · 2019: 74 · 2018: 69 · 2017: 61 · 2016: 54 · 2015: 49 · 2014: 39 · 2013: 25 · 2012: 4
- FWCI
- 2.76
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Psychiatric Clinics of North America (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institutes of Health (5r13mh066849-04, 5r01mh069864-04, 5r01mh070884-05)
- National Institute of Mental Health (R13-MH-066849, R01‐MH070884, U13MH066849, R01‐MH069864)
- National Institute on Drug Abuse (K05DA015799, R01DA016558)
- Fogarty International Center (R03TW006481)
- Topics
- Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
- Health Sciences › Medicine › Pharmacology › Treatment of Major Depression
- Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Health Systems, Economic Evaluations, Quality of Life
- Keywords
- major depressive disorder, cost-effectiveness, treatment rates, comorbidities, early treatment, role performance, epidemiology of depression
- MeSH terms
- Absenteeism, Major Depressive Disorder, Humans, Morbidity, Global Health, Prevalence, Health Care Costs, Cost of Illness
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