Research reportLevels of disability in Major Depression: Findings from the Netherlands Mental Health Survey and Incidence Study (NEMESIS)
Section snippets
Background
Recent community surveys reveal an alarmingly high prevalence of Major Depression (MD) in several developed countries (Kessler et al., 1994, Offord et al., 1996, Australian Bureau of Statistics, 1997, Bijl et al., 1998a). In addition, the impact of MD on the daily functioning of the individual is strong (Broadhead et al., 1990, Kessler et al., 1997, Bijl and Ravelli, 2000), and the limitations in well-being and functioning of patients have been shown to be equal to or greater than those of
Study sample
Data were collected in the Netherlands Mental Health Survey and Incidence Study (NEMESIS). The methods used have been described elsewhere by Bijl et al., 1998a, Bijl et al., 1998b. Briefly, the survey was based on a three-stage, stratified random sample drawn from the Dutch general adult population, aged 18–64. An initial sample was drawn from a population of 90 Dutch municipalities, stratified by urbanicity and province, the next from a population of private households (addresses from post
The study population
The characteristics of the total sample of the NEMESIS survey, and of the individuals diagnosed with MD in the past year and month are shown in Table 1. The unweighted prevalence of MD in the last year in the total NEMESIS sample was 6.2%. The generally reported prevalence of MD weighted for sex, age, urbanicity and marital status is 5.8% (NEMESIS, Bijl et al., 1998a). Compared to non-depressed individuals, depressed individuals were significantly more likely to be female, to report more
Discussion
We compared disability as measured by the SF-36, numbers of days ill in bed and number of absence days, between MD ‘type’ (single and recurrent) and ‘severity’, diagnosed according to the DSM-III-R. Recurrent episode MD was not found to be associated with more disability than single episode MD. Higher ‘severity’ classes on the other hand (‘mild’, ‘moderate’, ‘severe’ and ‘severe MD with psychotic features’) were associated with increasing levels of disability, although not all classes differed
Conclusion
The DSM-III-R diagnosis of ‘severity’ classes provides information on the disability associated with MD. Diagnosis of MD ‘type’, on the other hand, did not. Consequently, the diagnosis of ‘severity’ can be used to estimate the distribution of disability in the depressed population, information that is important for health policy and planning. Broken down according to disability level, only three groups of MD could be distinguished: ‘mild’, ‘moderate to severe’, and ‘severe MD with psychotic
Acknowledgments
We are specifically grateful to Dr N.N. Nagelkerke for his assistance with the statistical analyses. Furthermore, we would like to thank Professor P.J.M. van der Maas, Professor D. Kromhout, Dr P.G.N. Kramers and Dr J.J. Barendregt for their constructive comments on this paper.
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