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A 40-Year Perspective on the Prevalence of Depression
The Stirling County Study
Jane M. Murphy, PhD;
Nan M. Laird, PhD;
Richard R. Monson, MD, DSc;
Arthur M. Sobol, MA;
Alexander H. Leighton, MD
Arch Gen Psychiatry. 2000;57:209-215.
Background According to epidemiologic studies that use recall of lifetime episodes, the prevalence of depression is increasing. This report from the Stirling County Study compares rates of current depression among representative samples of adults from a population in Atlantic Canada.
Methods Sample sizes were 1003, 1201, and 1396 in 1952, 1970, and 1992, respectively. The depression component of the study's method, the DPAX (DP for depression and AX for anxiety), was employed. The original procedure (DPAX-1) was applied in all years. A revision (DPAX-2) was used in 1970 and 1992. The Diagnostic Interview Schedule (DIS) was also used in 1992.
Results With the DPAX-1, the overall prevalence of current depression was steady at 5% over the 2 early samples but declined in 1992 because of vernacular changes referring to dysphoria. The DPAX-2 gave a stable overall prevalence of 5% in the 2 recent samples, but indicated that women and younger people were at greater risk in 1992 than in 1970. The DIS, like the DPAX-2, found a current 1992 rate of 5% for major depressive episodes combined with dysthymia. Recalled lifetime rates using the DIS showed the same profile interpreted in other studies as suggesting an increase in depression over time.
Conclusions Three samples over a 40-year period showed a stable current prevalence of depression using the DPAX methods that was comparable in 1992 with the current rates using the DIS. This casts doubt on the interpretation that depression is generally increasing. Within the overall steady rate observed in this study, historical change was a matter of redistribution by sex and age, with a higher rate among younger women being of recent origin.
From the Departments of Psychiatry, Harvard Medical School (Dr Murphy) and Massachusetts General Hospital (Dr Murphy and Mr Sobol); the Departments of Epidemiology (Drs Murphy and Monson) and Biostatistics (Dr Laird), Harvard School of Public Health, Boston, Mass; and the Departments of Psychiatry and of Community Health and Epidemiology, Dalhousie University, Halifax, Nova Scotia (Dr Leighton).
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