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Major depressive disorder (MDD) as defined under DSM-5 criteria is highly prevalent among U.S. adults, according to new research.

Based upon findings of a large survey, 20.6% of respondents reported lifetime MDD, while 10.4% reported at least one episode of MDD in the past year, reported Deborah S. Hasin, PhD, of Columbia University Medical Center in New York, and colleagues in .

"[N]ational epidemiologic information on MDD is limited to pre-DSM-5 studies conducted more than 15 years ago," the group wrote, adding that the DSM-IV MDD diagnosis "was associated with impairment, psychiatric and substance use disorders (SUDs), poor health, mortality, disease and economic burden, and disability-years."

Some of the changes included with the DSM-5 diagnosis are the addition of specifiers, as well as removing the bereavement exclusion criteria. The authors explained that although the "DSM-5 does not include bereavement as a new MDD specifier, exploring the potential influence of this change on national rates of DSM-5 MDD by identifying the proportion of MDD cases that would have been excluded as bereavement under DSM-IV rules is of considerable interest."

The analysis drew upon the 2012-2013 National Epidemiologic Survey on Alcohol and Related Conditions III (NESARC-III), which included responses from 36,309 U.S. adults.

Women reported a higher prevalence for both a 12-month (13.4% versus 7.2%) and lifetime history (26.1% versus 14.7%) of MDD compared with men. White individuals also had a higher prevalence of both 12-month and lifetime MDD compared to African American, Asian/Pacific Islander, and Hispanic adults. However, Native Americans had the highest prevalence out of all ethnicities. The oldest age group -- including those 65 years and older -- had the lowest prevalence of both 12-month and lifetime MDD. Odds of MDD were higher among adults in the lowest tier of annual family income (≤$19,999), with the association decreasing with rising income.

MDD was also found to be highly comorbid, with strong associations with several other psychiatric conditions with 12-month and lifetime MDD, respectively:

• Substance use disorder: aOR 2.0 (95% CI 1.84-2.16); aOR 2.2 (95% CI 2.02-2.31)
• Any anxiety disorder: aOR 4.2 (95% CI 3.81-4.57); aOR 3.9 (95% CI 3.57-4.17)
• Any personality disorder: aOR 4.6 (95% CI 4.12-5.03); aOR 3.9 (95% CI 3.58-4.29)

All clusters of personality disorder -- schizotypal, borderline, and antisocial -- had high odds for comorbidity with MDD. Similar findings were seen among types of anxiety, which included panic, agoraphobia, social phobia, specific phobia, GAD, and PTSD. There were also increased odds of comorbidity for all types of substance use disorders, including alcohol, any drug, and nicotine use.

Nearly 70% of all respondents with lifetime MDD reported some form of treatment, with the most common treatment being talk therapy with a professional. However, only around half of those with MDD beginning within the past 12 months reported receiving some form of treatment.

Hasin and colleagues could not, however, resolve the controversy over DSM-5's elimination of the "bereavement exclusion." Critics had predicted it would open the door to "medicalizing" normal grief with an accompanying surge in antidepressant prescriptions.

In the current study, among participants reporting having MDD at some point, 12.9% had all such episodes begin shortly after a loved one's death and lasting less than 2 months -- in other words, potentially classifiable as bereavement. If extended to the general population, it would be a large number of people.

But the study did not address how many of those episodes received treatment, although the findings of no great change in the percentage of MDD episodes overall receiving treatment do not support the critics' worst fears.

"Based on this consistent picture of increasing depression indicators from multiple sources, we suggest that a prudent public health response would be to take these increases seriously in formulating service delivery and policy rather than dismissing all of the findings, including the NESARC to NESARC-III increases, on methodological grounds," urged the research group. "Of some interest is whether participants diagnosed as having MDD in NESARC and NESARC-III differ on severity indicators, including suicide attempts and hospitalization rates, a useful topic to address in a future study."

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