Article1992

Service Utilization and Social Morbidity Associated With Depressive Symptoms in the Community

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Mental Health Treatment and Access Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes Treatment of Major Depression

Abstract

OBJECTIVE: To estimate service utilization and social morbidity in the community associated with depressive symptoms. Estimates were made using an epidemiologic measure, population attributable risk. Population attributable risk is a compound measure reflecting both the morbid risk to an individual with a disorder and the prevalence of the disorder in the community. DESIGN: Epidemiologic survey. PARTICIPANTS: Eighteen thousand five hundred seventy-one adults in the Epidemiologic Catchment Area Study interviewed from a complex random sample in five US communities. OUTCOME MEASURES: Suicide attempts, use of psychoactive medications, self-reported physical and emotional health, time lost from work, and general medical services or use of emergency departments for emotional problems. RESULTS: Major depression-dysthymia (lifetime prevalence, 6.1%) and depressive symptoms (lifetime prevalence, 23.1%) were associated with increased service utilization and social morbidity as measured by the outcome variables. On a population basis, however, as much or more service burden and impairment was associated with depressive symptoms as with the clinical conditions of depression or dysthymia. The equal association results from the greater prevalence of depressive symptoms. Population attributable risk percentages associated with depressive symptoms (not disorder) were as follows: emergency department use (11.8%) or medical consultations for emotional problems (21.5%); use of tranquilizers (14.6%), sleeping pills (21.0%), or antidepressants (22.2%); fair or poor self-reported emotional health (15.3%); days lost from work (17.8%); and suicide attempts (25.0%). CONCLUSIONS: Estimates of population attributable risk indicated that physicians actually provided services to more persons with depressive symptoms than to persons with formally defined conditions of depressive disorders. Subclinical depression, as a consequence of high prevalence, is a clinical and public health problem. Attention to diagnostic and treatment issues is indicated.

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References

1978Research Diagnostic Criteria 1981National Institute of Mental Health Diagnostic Interview Schedule 1989The functioning and well-being of depressed patients. Results from the Medical Outcomes Study 1984The NIMH Epidemiologic Catchment Area Program 1990Depression, Disability Days, and Days Lost From Work in a Prospective Epidemiologic Survey 1980Nonspecific Psychological Distress and Other Dimensions of Psychopathology 1990Comorbidity of mood and anxiety disorders 1985A Comparison of Clinical and Diagnostic Interview Schedule Diagnoses

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