{"doi":"10.1001/jama.289.23.3095","title":"The Epidemiology of Major Depressive Disorder","abstract":"<h4>Context</h4>Uncertainties exist about prevalence and correlates of major depressive disorder (MDD).<h4>Objective</h4>To present nationally representative data on prevalence and correlates of MDD by Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) criteria, and on study patterns and correlates of treatment and treatment adequacy from the recently completed National Comorbidity Survey Replication (NCS-R).<h4>Design</h4>Face-to-face household survey conducted from February 2001 to December 2002.<h4>Setting</h4>The 48 contiguous United States.<h4>Participants</h4>Household residents ages 18 years or older (N = 9090) who responded to the NCS-R survey.<h4>Main outcome measures</h4>Prevalence and correlates of MDD using the World Health Organization's (WHO) Composite International Diagnostic Interview (CIDI), 12-month severity with the Quick Inventory of Depressive Symptomatology Self-Report (QIDS-SR), the Sheehan Disability Scale (SDS), and the WHO disability assessment scale (WHO-DAS). Clinical reinterviews used the Structured Clinical Interview for DSM-IV.<h4>Results</h4>The prevalence of CIDI MDD for lifetime was 16.2% (95% confidence interval [CI], 15.1-17.3) (32.6-35.1 million US adults) and for 12-month was 6.6% (95% CI, 5.9-7.3) (13.1-14.2 million US adults). Virtually all CIDI 12-month cases were independently classified as clinically significant using the QIDS-SR, with 10.4% mild, 38.6% moderate, 38.0% severe, and 12.9% very severe. Mean episode duration was 16 weeks (95% CI, 15.1-17.3). Role impairment as measured by SDS was substantial as indicated by 59.3% of 12-month cases with severe or very severe role impairment. Most lifetime (72.1%) and 12-month (78.5%) cases had comorbid CIDI/DSM-IV disorders, with MDD only rarely primary. Although 51.6% (95% CI, 46.1-57.2) of 12-month cases received health care treatment for MDD, treatment was adequate in only 41.9% (95% CI, 35.9-47.9) of these cases, resulting in 21.7% (95% CI, 18.1-25.2) of 12-month MDD being adequately treated. Sociodemographic correlates of treatment were far less numerous than those of prevalence.<h4>Conclusions</h4>Major depressive disorder is a common disorder, widely distributed in the population, and usually associated with substantial symptom severity and role impairment. While the recent increase in treatment is encouraging, inadequate treatment is a serious concern. Emphasis on screening and expansion of treatment needs to be accompanied by a parallel emphasis on treatment quality improvement.","journal":"JAMA","year":2003,"id":7703,"datarank":16.12367005853253,"base_score":8.98343977178426,"endowment":8.98343977178426,"self_citation_contribution":1.3475159657676392,"citation_network_contribution":14.776154092764891,"self_endowment_contribution":1.3475159657676392,"citer_contribution":14.776154092764891,"corpus_percentile":90.0,"corpus_rank":1696,"citation_count":7969,"citer_count":185,"citers_with_citation_signal":185,"citers_with_endowment":185,"datacite_reuse_total":0,"is_dataset":false,"is_oa":false,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2003-06-18","authors":[{"id":69362,"name":"Patricia Berglund","orcid":null,"position":1,"is_corresponding":false},{"id":69363,"name":"Olga Demler","orcid":"0000-0003-3355-3210","position":2,"is_corresponding":false},{"id":69364,"name":"Robert Jin","orcid":null,"position":3,"is_corresponding":false},{"id":69365,"name":"Doreen Koretz","orcid":null,"position":4,"is_corresponding":false},{"id":69366,"name":"Kathleen R. Merikangas","orcid":"0000-0002-4667-2414","position":5,"is_corresponding":false},{"id":69367,"name":"A. John Rush","orcid":"0000-0003-2004-2382","position":6,"is_corresponding":false},{"id":69368,"name":"Ellen E. Walters","orcid":null,"position":7,"is_corresponding":false},{"id":69369,"name":"Philip S. Wang","orcid":"0009-0001-4227-5593","position":8,"is_corresponding":false},{"id":69370,"name":"Patricia A. Berglund","orcid":"0000-0001-5952-6021","position":9,"is_corresponding":false},{"id":59273,"name":"Ronald C. Kessler","orcid":"0000-0003-4831-2305","position":0,"is_corresponding":true}],"reference_count":46,"raw_metadata":{"citation_network_status":"fetched"},"created_at":"2026-03-01T18:20:47.508186Z","pmid":null,"pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}