Levels of disability in Major Depression: Findings from the Netherlands Mental Health Survey and Incidence Study (NEMESIS)

doi:10.1016/S0165-0327(02)00099-X

Journal of Affective Disorders

Volume 77, Issue 1, October 2003, Pages 53-64

https://doi.org/10.1016/S0165-0327(02)00099-X Get rights and content

Abstract

Background: Information on the distribution of disability associated with major depression (MD) across different groups of patients is of interest to health policy and planning. We examined the associations of severity and type (a single or recurrent episode) of MD with disability in a Dutch general population sample. Methods: We used data from the first wave (1996) of the Netherlands Mental Health Survey and Incidence Study (NEMESIS). MD ‘severity’ and ‘type’ were diagnosed with the help of the Composite International Diagnostic Interview according to DSM-III-R criteria. SF-36 scores, days ill in bed and days absent from work were taken as indicators of disability. The differences in these variables were studied by means of variance and regression analysis. Results: Recurrent MD was found not to be associated with more disability than single episode MD. Higher ‘severity’ classes were associated with more disability. However, the degree of disability between ‘moderate’ and ‘severe’ MD differed only very slightly. The difference in disability between non-depressed and mildly depressed individuals had a larger effect than between each successive pair of ‘severity’ classes. Conclusions: Three groups of MD can be distinguished based on the associated degree of disability: ‘mild’, ‘moderate to severe’ and ‘severe with psychotic features’. In the future, these groups can be used to describe the distribution of disability in the depressed population. The marked difference between ‘mild’ MD and no MD suggests that ‘mild’ cases should be considered relevant.

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.

References (32)

N.K. Aaronson et al.
Translation, validation, and norming of the Dutch language version of the SF-36 Health Survey in community and chronic disease populations
J. Clin. Epidemiol.
(1998)
R.C. Kessler et al.
Prevalence, correlates, and course of minor depression and major depression in the National Comorbidity Survey
J. Affect. Disord.
(1997)
M.A. Sprangers et al.
Which chronic conditions are associated with better or poorer quality of life?
J. Clin. Epidemiol.
(2000)
L.M. Verbrugge et al.
The disablement process
Soc. Sci. Med.
(1994)
H.U. Wittchen
Reliability and validity studies of the WHO—Composite International Diagnostic Interview (CIDI): a critical review
J. Psychiatr. Res.
(1994)
Diagnostic and Statistical Manual of Mental Disorders: DSM-III-R
(1987)
Mental Health and Wellbeing: Profile of Adults, Australia
(1997)
A.T. Beekman et al.
Consequences of major and minor depression in later life: a study of disability, well-being and service utilization
Psychol. Med.
(1997)
K.M. Beusterien et al.
Usefulness of the SF-36 Health Survey in measuring health outcomes in the depressed elderly
J. Geriatr. Psychiatry Neurol.
(1996)
R.V. Bijl et al.
Current and residual functional disability associated with psychopathology: findings from the Netherlands Mental Health Survey and Incidence Study (NEMESIS)
Psychol. Med.
(2000)

R.V. Bijl et al.

Prevalence of psychiatric disorder in the general population: results of The Netherlands Mental Health Survey and Incidence Study (NEMESIS)

Soc. Psychiatry Psychiatr. Epidemiol.

(1998)

R.V. Bijl et al.

The Netherlands Mental Health Survey and Incidence Study (NEMESIS): objectives and design

Soc. Psychiatry Psychiatr. Epidemiol.

(1998)

W.E. Broadhead et al.

Depression, disability days, and days lost from work in a prospective epidemiologic survey

J. Am. Med. Assoc.

(1990)

T.S. Brugha et al.

A general population comparison of the Composite International Diagnostic Interview (CIDI) and the Schedules for Clinical Assessment in Neuropsychiatry (SCAN)

Psychol. Med.

(2001)

J. Cohen

Statistical Power Analysis For the Behavioural Sciences

(1977)

S. Henderson et al.

Non-disabled cases in a national survey

Psychol. Med.

(2001)

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Research reportLevels of disability in Major Depression: Findings from the Netherlands Mental Health Survey and Incidence Study (NEMESIS)

Abstract

Section snippets

Background

Study sample

The study population

Discussion

Conclusion

Acknowledgments

J. Clin. Epidemiol.

J. Affect. Disord.

J. Clin. Epidemiol.

Soc. Sci. Med.

J. Psychiatr. Res.

Diagnostic and Statistical Manual of Mental Disorders: DSM-III-R

Mental Health and Wellbeing: Profile of Adults, Australia

Consequences of major and minor depression in later life: a study of disability, well-being and service utilization

Psychol. Med.

Usefulness of the SF-36 Health Survey in measuring health outcomes in the depressed elderly

J. Geriatr. Psychiatry Neurol.

Current and residual functional disability associated with psychopathology: findings from the Netherlands Mental Health Survey and Incidence Study (NEMESIS)

Psychol. Med.

Prevalence of psychiatric disorder in the general population: results of The Netherlands Mental Health Survey and Incidence Study (NEMESIS)

Soc. Psychiatry Psychiatr. Epidemiol.

The Netherlands Mental Health Survey and Incidence Study (NEMESIS): objectives and design

Soc. Psychiatry Psychiatr. Epidemiol.

Depression, disability days, and days lost from work in a prospective epidemiologic survey

J. Am. Med. Assoc.

A general population comparison of the Composite International Diagnostic Interview (CIDI) and the Schedules for Clinical Assessment in Neuropsychiatry (SCAN)

Psychol. Med.

Statistical Power Analysis For the Behavioural Sciences

Non-disabled cases in a national survey

Psychol. Med.

Research report
Levels of disability in Major Depression: Findings from the Netherlands Mental Health Survey and Incidence Study (NEMESIS)