DSM-5 Criteria for Major Depressive Disorder (MDD)
1- Five (or more) of the following symptoms have been present during the same 2 – week period and represent a change from previous functioning; at least one of the symptoms is either (1) depressed mood or (2) loss of interest or pleasure.
2-Depressed mood most of the day, almost every day, indicated by your own subjective report or by the report of others. This mood might be characterized by sadness, emptiness, or hopelessness.
3- Markedly diminished interest or pleasure in all or almost all activities most of the day nearly every day.
4- Significant weight loss when not dieting or weight gain.
5- Inability to sleep or oversleeping nearly every day.
6- Psychomotor agitation or retardation nearly every day.
7- Fatigue or loss of energy nearly every day.
8- Feelings of worthlessness or excessive or inappropriate guilt (which may be delusional) nearly every day.
9- Diminished ability to think or concentrate, or indecisiveness, nearly every day.
10- Recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide.
11- Symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning
12- The episode is not due to the effects of a substance or to a medical condition
13- The occurrence is not better explained by schizoaffective disorder, schizophrenia, schizophreniform disorder, delusional disorder, or other specified and unspecified schizophrenia spectrum and other psychotic disorders
14- There has never been a manic episode or a hypomanic episode
When trying to make a diagnosis, we look for a constellation of symptoms that points to the underlying issue. This is the same whether we are dealing with strictly medical problems or with mental disorders. The most important thing to remind yourself about before labeling yourself as ‘depressed’, possibly exacerbating your problem, is that you need a lot of symptoms going on at the same time to qualify. It’s not enough to just be feeling down in the dumps.
Lifestyle Correlations with Depression
Although there are many causes of depression, some of which may be genetic, decades of research on mental health conditions have revealed correlations between certain lifestyle factors and increased depression rates. Individuals with less than a high school education are more likely to suffer from depression than those with a high school diploma or more advanced degree. Involuntary unemployment—regardless of its cause—is also elevated among those reporting depression. Since depression is a leading cause of disability in the U.S., it may lead to increased unemployment and decreased quality of life. Those who have gone through a divorce have a higher risk of depression. Statistics indicate that men are more likely than women to suffer depression after a divorce.
Sex, Age, and Ethnicity in Depression
Depression rates vary by gender, age, and ethnicity. In general, women are at higher risk of depression than men, ethnic minorities are at greater risk of depression than non-Hispanic whites, and adults aged 45-64 are more likely than any other age group to have a diagnosis of depression. Women are twice as likely to have depression, and symptoms of depression, as men of the same age. 12% of all women in the United States will experience symptoms of clinical depression at some point in their lives. Approximately one in ten women experience symptoms of depression in the weeks after having a baby.
The Behavioral Risk Factor Surveillance System found that the rate of diagnosed major depression increased with age from 2.8% for adults 18-24 to a peak of 4.6% for adults 45-64 years. 4% of adolescents will develop significant symptoms of serious depression each year in the United States. Suicide is the third leading cause of death among children and young adults aged 10 to 24. For every 33 children in school, one child will have clinical depression. About 50% of all adults experiencing symptoms of depression will not talk to a doctor or seek help for depression.
The prevalence of diagnosed depression varies throughout the United States. Although the number of new cases changes every year and many people are successfully treated for their depression symptoms, rates of diagnosed depression continue to increase. 6.6% of the U.S. adult population will experience major depression within a 12-month period.
Rates of diagnosis of depression vary based on states. In 2006-2008, North Dakota had the lowest rate (4.8%) while Mississippi had the highest rate (14.8%), according to Behavioral Risk Factor Surveillance System data. Bipolar disorder, which involves alternating periods of depression and mania, affects about 6 million people in the United States, or about 3% of the total adult population. Over 80% of people with symptoms of clinical depression are not receiving any specific treatment for their depression. According to a study done at Harvard, the number of patients diagnosed with depression increases by approximately 20% per year.
Medical Costs and Care
Individuals suffering from depression (diagnosed or otherwise) consume considerably more health services than similar individuals without depression symptoms. Depression is a growing concern for healthcare costs and insurance, particularly as rates of diagnosed depression steadily increase. The World Health Association reports that 60-80% of all depression cases can be effectively treated with brief, structured forms of psychotherapy and antidepressant medications.
In a study of 14,903 individuals on Medicare in the United States, 2,108 had depression and 1,081 were not officially diagnosed despite reporting clinical symptoms of depression or taking antidepressant medication. Most of the patients also suffered from serious comorbid conditions, such as diabetes or heart disease. In the same study of health care costs, those currently diagnosed with depression had healthcare costs of approximately $22,960 in a one-year period. Those without any signs of depression had healthcare costs approximately half that of those with a diagnosis ($11,956). Those reporting depression symptoms but no depression diagnosis had average healthcare costs of $14,365.
Although many countries have too little data available to accurately calculate rates of depression diagnoses and symptoms, several international studies and organizations have begun to conduct research on depression and its effects worldwide.
An estimated 121 million people worldwide are currently living with some form of depression. Of these individuals, fewer than 25% have access to adequate treatment. The World Health Organization considers depression the fourth leading cause of disability worldwide, and expects it to become the second leading cause of disability worldwide by 2020.
In the United Kingdom, an estimated one in four people will experience some kind of mental health problem in a given year, with mixed anxiety and depression the most commonly diagnosed. Depression alone impacts one in five elderly people in the UK. Worldwide, women are about twice as likely to experience depression as men. High-income countries tend to have higher rates of depression than lower income countries. Countries with the highest lifetime prevalence of Major Depressive Episodes (MDE) are France, the Netherlands, the United States (each with over 30% of the population ever experiencing an MDE), and India (36%). High-income countries together average 28.1%, and low- and middle-income countries average 19.8% in prevalence of a lifetime MDE.