title: Describing the population health burden of depression: health-adjusted life expectancy by depression status in Canada.
abstract: BACKGROUND
  Few studies have evaluated the impact of depression in terms of losses to both premature mortality and health-related quality of life (HRQOL) on the overall population. Health-adjusted life expectancy (HALE) is a summary measure of population health that combines both morbidity and mortality into a single summary statistic that describes the current health status of a population.
  
  
  METHODS
  We estimated HALE for the Canadian adult population according to depression status. National Population Health Survey (NPHS) participants 20 years and older (n = 12 373) were followed for mortality outcomes from 1994 to 2009, based on depression status. Depression was defined as having likely experienced a major depressive episode in the previous year as measured by the Composite International Diagnostic Interview Short Form. Life expectancy was estimated by building period abridged life tables by sex and depression status using the relative risks of mortality from the NPHS and mortality data from the Canadian Chronic Disease Surveillance System (2007-2009). The Canadian Community Health Survey (2009/10) provided estimates of depression prevalence and Health Utilities Index as a measure of HRQOL. Using the combined mortality, depression prevalence and HRQOL estimates, HALE was estimated for the adult population according to depression status and by sex.
  
  
  RESULTS
  For the population of women with a recent major depressive episode, HALE at 20 years of age was 42.0 years (95% CI: 40.2-43.8) compared to 57.0 years (95% CI: 56.8-57.2) for women without a recent major depressive episode. For the population of Canadian men, HALE at 20 was 39.0 years (95% CI: 36.5-41.5) for those with a recent major depressive episode compared to 53.8 years (95% CI: 53.6-54.0) for those without. For the 15.0-year difference in HALE between women with and without depression, 12.3 years can be attributed to the HRQOL gap and the remaining 2.7 years to the mortality gap. The 14.8 fewer years of HALE observed for men with depression equated to a 13.0-year HRQOL gap and a 1.8-year mortality gap.
  
  
  CONCLUSIONS
  The population of adult men and women with depression in Canada had substantially lower healthy life expectancy than those without depression. Much of this gap is explained by lower levels of HRQOL, but premature mortality also plays a role.
authors: Health Promotion and Chronic Disease Prevention Branch, Public Health Agency of Canada, Government of Canada, Ottawa, Ontario, Canada.|Department of Social and Preventive Medicine, Université de Montréal, Montréal, Quebec, Canada.
authors: C
authors: C
authors: Steensma
authors: Health Promotion and Chronic Disease Prevention Branch, Public Health Agency of Canada, Government of Canada, Ottawa, Ontario, Canada.
authors: L
authors: L
authors: Loukine
authors: Health Promotion and Chronic Disease Prevention Branch, Public Health Agency of Canada, Government of Canada, Ottawa, Ontario, Canada.|School of Psychology, University of Ottawa, Ottawa, Ontario, Canada.
authors: H
authors: H
authors: Orpana
authors: Health Promotion and Chronic Disease Prevention Branch, Public Health Agency of Canada, Government of Canada, Ottawa, Ontario, Canada.
authors: L
authors: L
authors: McRae
authors: Health Promotion and Chronic Disease Prevention Branch, Public Health Agency of Canada, Government of Canada, Ottawa, Ontario, Canada.
authors: J
authors: J
authors: Vachon
authors: Health Promotion and Chronic Disease Prevention Branch, Public Health Agency of Canada, Government of Canada, Ottawa, Ontario, Canada.
authors: F
authors: F
authors: Mo
authors: Health Promotion and Chronic Disease Prevention Branch, Public Health Agency of Canada, Government of Canada, Ottawa, Ontario, Canada.|Department of Social and Preventive Medicine, Université de Montréal, Montréal, Quebec, Canada.
authors: M
authors: M
authors: Boileau-Falardeau
authors: Health Promotion and Chronic Disease Prevention Branch, Public Health Agency of Canada, Government of Canada, Ottawa, Ontario, Canada.
authors: C
authors: C
authors: Reid
authors: Health Promotion and Chronic Disease Prevention Branch, Public Health Agency of Canada, Government of Canada, Ottawa, Ontario, Canada.|Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.|Injury Prevention Research Center, Shantou University Medical College, Shantou, China.
authors: B C
authors: BC
authors: Choi
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002170:Canada / Q000453:epidemiology; D003071:Cognition; D003863:Depression / Q000453:epidemiology* / Q000523:psychology*; D004644:Emotions; D005260:Female; D006304:Health Status; D006306:Health Surveys; D006801:Humans; D008017:Life Expectancy; D008297:Male; D008875:Middle Aged; D061213:Mortality, Premature; D010146:Pain / Q000523:psychology; D015995:Prevalence; D011788:Quality of Life; D055815:Young Adult
keywords: depression; health-related quality of life; healthy life expectancy; life expectancy; mortality