title: The impact of depression is unevenly distributed in the population.
abstract: OBJECTIVE
  The aim of this study was to evaluate the impact of depression on quality of life in the general population by studying its effects on i) health-related quality of life (HRQoL), ii) health state utilities, and iii) the burden of disease in the population according to age, sex, marital status, education, economy and employment.
  
  
  METHODS
  Cross-sectional survey in the County of Uppsala, Sweden. A statistical sample of the general population aged 20-64 years (N=4506) was used. Information on current state of depression was obtained by self-report. HRQoL was measured using Short Form 36 (SF-36). The time trade-off (TTO) method was used to measure health state utilities. The decrease of total health state utilities associated with depression in the population was used as a measure of burden of disease.
  
  
  RESULTS
  Depression was reported by 4.0% of the population. Those with depression scored significantly lower (P<0.001) than those without on all eight of the SF-36 domains. The depressed group also rated their health state utilities significantly lower than the others: 0.796 versus 0.933 (P<0.001). In the multivariate analysis of decrease in utilities with various medical disorders, depression was associated with the greatest decrease (-0.090, P<0.001). Persons with depression accounted for 10.9% of the total decrease in utilities in the whole population, but this proportion varied according to the specific subgroup. For example, 16.4% and 8.6% of the total burden of disease was linked to depression among single and married people, respectively. The corresponding figures for those with the lowest and highest incomes were 15.0% and 7.9%, respectively. Among the unemployed, persons reporting depression accounted for 15.3% of the decrease in utilities in contrast to 4.9% among the employed.
  
  
  CONCLUSIONS
  Depression has a strong impact on the quality of life and total disability in the general population. Further, the impact of depression is unevenly distributed in the population.
authors.affiliation: Department of Pharmacy, Pharmacoepidemiology and Pharmacoeconomics, Uppsala University, Box 580, BMC, SE-751 23 Uppsala, Sweden. Dag.Isacson@farmaci.uu.se
authors.forename: Dag
authors.initials: D
authors.lastname: Isacson
authors.forename: Kerstin
authors.initials: K
authors.lastname: Bingefors
authors.forename: Lars
authors.initials: L
authors.lastname: von Knorring
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002391:Catchment Area, Health; D017281:Cost of Illness; D003430:Cross-Sectional Studies; D003863:Depression / Q000453:epidemiology* / Q000523:psychology; D004522:Educational Status; D004651:Employment / Q000706:statistics & numerical data; D005260:Female; D006304:Health Status; D006801:Humans; D008297:Male; D017533:Marital Status; D008875:Middle Aged; D011159:Population Surveillance; D015995:Prevalence; D011788:Quality of Life / Q000523:psychology; D012042:Registries; D012720:Severity of Illness Index; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D013548:Sweden / Q000453:epidemiology