title: Cross-national epidemiology of DSM-IV major depressive episode.
abstract: BACKGROUND
  Major depression is one of the leading causes of disability worldwide, yet epidemiologic data are not available for many countries, particularly low- to middle-income countries. In this paper, we present data on the prevalence, impairment and demographic correlates of depression from 18 high and low- to middle-income countries in the World Mental Health Survey Initiative.
  
  
  METHODS
  Major depressive episodes (MDE) as defined by the Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DMS-IV) were evaluated in face-to-face interviews using the World Health Organization Composite International Diagnostic Interview (CIDI). Data from 18 countries were analyzed in this report (n = 89,037). All countries surveyed representative, population-based samples of adults.
  
  
  RESULTS
  The average lifetime and 12-month prevalence estimates of DSM-IV MDE were 14.6% and 5.5% in the ten high-income and 11.1% and 5.9% in the eight low- to middle-income countries. The average age of onset ascertained retrospectively was 25.7 in the high-income and 24.0 in low- to middle-income countries. Functional impairment was associated with recency of MDE. The female: male ratio was about 2:1. In high-income countries, younger age was associated with higher 12-month prevalence; by contrast, in several low- to middle-income countries, older age was associated with greater likelihood of MDE. The strongest demographic correlate in high-income countries was being separated from a partner, and in low- to middle-income countries, was being divorced or widowed.
  
  
  CONCLUSIONS
  MDE is a significant public-health concern across all regions of the world and is strongly linked to social conditions. Future research is needed to investigate the combination of demographic risk factors that are most strongly associated with MDE in the specific countries included in the WMH.
authors.affiliation: Department of Psychiatry, State University of New York at Stony Brook, South Campus, Stony Brook, NY 11794-8790, NY, USA. ebromet@notes.cc.sunysb.edu
authors.forename: Evelyn
authors.initials: E
authors.lastname: Bromet
authors.forename: Laura Helena
authors.initials: LH
authors.lastname: Andrade
authors.forename: Irving
authors.initials: I
authors.lastname: Hwang
authors.forename: Nancy A
authors.initials: NA
authors.lastname: Sampson
authors.forename: Jordi
authors.initials: J
authors.lastname: Alonso
authors.forename: Giovanni
authors.initials: G
authors.lastname: de Girolamo
authors.forename: Ron
authors.initials: R
authors.lastname: de Graaf
authors.forename: Koen
authors.initials: K
authors.lastname: Demyttenaere
authors.forename: Chiyi
authors.initials: C
authors.lastname: Hu
authors.forename: Noboru
authors.initials: N
authors.lastname: Iwata
authors.forename: Aimee N
authors.initials: AN
authors.lastname: Karam
authors.forename: Jagdish
authors.initials: J
authors.lastname: Kaur
authors.forename: Stanislav
authors.initials: S
authors.lastname: Kostyuchenko
authors.forename: Jean-Pierre
authors.initials: JP
authors.lastname: Lépine
authors.forename: Daphna
authors.initials: D
authors.lastname: Levinson
authors.forename: Herbert
authors.initials: H
authors.lastname: Matschinger
authors.forename: Maria Elena Medina
authors.initials: ME
authors.lastname: Mora
authors.forename: Mark Oakley
authors.initials: MO
authors.lastname: Browne
authors.forename: Jose
authors.initials: J
authors.lastname: Posada-Villa
authors.forename: Maria Carmen
authors.initials: MC
authors.lastname: Viana
authors.forename: David R
authors.initials: DR
authors.lastname: Williams
authors.forename: Ronald C
authors.initials: RC
authors.lastname: Kessler
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D003863:Depression / Q000175:diagnosis / Q000453:epidemiology*; D019049:Developed Countries; D003906:Developing Countries; D039721:Diagnostic and Statistical Manual of Mental Disorders; D005260:Female; D014943:Global Health; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D017678:Sex Distribution; D012959:Socioeconomic Factors; D055815:Young Adult