Epidemiology of Mood Disorders II: Analytic Epidemiology and the Search for Etiologic Clues. William W. Eaton, PhD Johns Hopkins University

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1 This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike License. Your use of this material constitutes acceptance of that license and the conditions of use of materials on this site. Copyright 2006, The Johns Hopkins University and William W. Eaton. All rights reserved. Use of these materials permitted only in accordance with license rights granted. Materials provided AS IS ; no representations or warranties provided. User assumes all responsibility for use, and all liability related thereto, and must independently review all materials for accuracy and efficacy. May contain materials owned by others. User is responsible for obtaining permissions for use from third parties as needed.

2 Epidemiology of Mood Disorders II: Analytic Epidemiology and the Search for Etiologic Clues William W. Eaton, PhD Johns Hopkins University

3 Epidemiology of Depression Risk Factors Sex/gender and natural history Diathesis/stress model Life event stressors Social supports Continued 3

4 Epidemiology of Depression Risk Factors Socioeconomic status (SES) and work life SES, social supports, and life stage Recency of birth 4

5 Gender Section A

6 Gender and Mood Disorders in Four Surveys Ages 26-64, Standardized to U.S. Age Distribution 20 MDD--Males BPD--Males 3.47/1 MDD--Females BPD--Females 1.98/1 Lifetime Prevalence (%) / / /1.86/1 NA.91/1 0 USA Edmonton Munich New Zealand Data from: Weissman, et al. (1993), J Affect Disord. 6

7 Risk Factors for Adult MDE Forest Plot Breslau, 1996 Catalano, 2000 Ginexi, 2000 Hwang, 2000 Kawakami, 1995 Messias, 2001 Patten, 2001 Pine, 1998 Female vs. Male Relative Risk/Odds Ratio Adapted from: Mielke et al,

8 Incidence, Recurrence, and Duration by Age and Sex Baltimore ECA Follow-Up Incidence RR Recurrence RR Duration in Weeks Male Female Recurrence *** *** Source: Eaton, et al. (1997), Arch Gen Psychiatry 8

9 Summary Prevalence of depression is higher in females than males Caused by relationship of incidence of depression to gender Gender operates only in the first episode 9

10 Stress, Heredity, and Social Support Section B

11 Diathesis Stress Model 11

12 ... in London Percent with Severe Events Prior to Onset Cases (Patients) Cases (Survey) Controls (Survey) One or More Severe Events No Severe Events 61% 68% 20% 39% 32% 80% Total Percent 100% 100% 100% Number of Persons Source: Brown and Harris (1978), Social Origins of Depression, pp ,

13 Interaction of Life Events and Heredity Onset of Major Depression in 2,164 Female Twins Percent with Onset DZ Co-Twin Normal MZ Co-Twin Normal DZ Co-Twin Case MZ Co-Twin Case 0 Absent Present Adapted from Kendler et al. (1995), Am J Psychiatry Severe Life Event in Month of Onset 13

14 Support Percent with Onset of Disorder Confidant No Confidant No Recent Life Stress 1% 3% Recent Life Stress 4% 38% Source: Brown, et al. (1975), Sociology 14

15 SES, Work, and Life Stage Section C

16 Odds Ratios for Prevalence of Major Depression in the Lower Socio-Economic Group Adapted from: Lorant, et al. (2003), Am J Epidemiol. 16

17 Odds Ratios of Major Depression Five Incidence and Four Persistence Studies Adapted from: Lorant, et al. (2003), Am J Epidemiol. 17

18 Predictors of Episodes of Depression Baseline (1981) Family Background Background Prevalence Father s job percentile Father s grade level.99*.99* Follow-Up ( ) Prevalence Incidence Parental Depression *** 1.59** 1.76** Highest grade, baseline.90* Job percentile of first job Occupational Career Job percentile at baseline Household income percentile, baseline Financial dependency at baseline *** 2.46** Job percentile at Follow-up Household income percentile, follow-up Other income, follow-up Prior year life events 1.55* 1.59*** * p <.1 ** p <.05 *** p <.01 + p <.005 Data from: Eaton, et al. (2001), J Health Soc Behav Continued 18

19 Predictors of Episodes of Depression Baseline (1981) Family Background Background Prevalence Father s job percentile Father s grade level.99*.99* Follow-Up ( ) Prevalence Incidence Parental Depression *** 1.59** 1.76** Highest grade, baseline.90* Job percentile of first job Occupational Career Job percentile at baseline Household income percentile, baseline Financial dependency at baseline *** 2.46** Job percentile at Follow-up Household income percentile, follow-up Other income, follow-up Prior year life events 1.55* 1.59*** * p <.1 ** p <.05 *** p <.01 + p <.005 Data from: Eaton, et al. (2001), J Health Soc Behav 19

20 Depression among Women in London Social Class, Life Stage, and Intimacy 100 Percent with Confidant (Top) Lower Class Middle Class Lower Class Middle Class 0 Young, No Children Child Less than Six Children 6 to 14 Children 15 and Over Older, No Children Percent with Depression (Bottom) Redrawn from Brown, Bhrolchain, and Harris (1975) Life Stage Continued 20

21 Depression among Women in London Social Class, Life Stage, and Intimacy 100 Percent with Confidant (Top) Lower Class Middle Class Lower Class Middle Class 0 Young, No Children Child Less than Six Children 6 to 14 Children 15 and Over Older, No Children Percent with Depression (Bottom) Redrawn from Brown, Bhrolchain, and Harris (1975) Life Stage 21

22 Risk Factors for Adult MDE Work Environment Job Overload Job Unsuitability Absenteeism from Work Absenteeism from Work High Psychological Demand High Psychological Demand Low Decision Latitude Low Decision Latitude High Job Strain High Job Strain High Job Insecurity High Job Insecurity Low Supervisor Support Low Supervisor Support a a b b b b b b c c c c c c Color Category Forest Plot Redrawn from Mielke, et al. (2002) Relative Risk/Odds Ratio

23 Recency of Birth Section D

24 Birth Cohort Cumulative Percent Ever Depressed Females in Five ECA Sites Births after 1935 Births before Redrawn from Wickramaratne, et al. (1989), J Clin Epidemiol. Age in Years 24

25 Community Settings the Cohort Effect Has Appeared Five urban areas in the United States Edmonton, Alberta Puerto Rico Munich Germany Paris, France Beirut, Lebanon Christchurch, New Zealand Taiwan Florence, Italy Source: Cross-National Collaborative Group, JAMA (1992) 25

26 Possible Explanations for Cohort Effects Older cohorts are less introspective More treatment available leads to better recall People with depression die sooner Older subjects forget more distant episodes 26

27 Recall Simulation and Major Depression 1% of Episodes Forgotten Each Year Redrawn from Giuffra and Risch (1994), Psycho Med. Continued 27

28 Recall Simulation and Major Depression 3% of Episodes Forgotten Each Year Redrawn from Giuffra and Risch (1994), Psycho Med. Continued 28

29 Recall Simulation and Major Depression Forgetting Increases with Age Cohort: 1900, 10%; 1930, 5%; 1960, 1% Redrawn from Giuffra and Risch (1994), Psycho Med. 29

30 Trends in Incidence of Depressive Disorder 30

31 Trend in Suicide among Youth Rates per 100,000 Population Holland US Rate Born after Adapted from: Diekstra (1993), Acta Psychiatr Scand Supl Year of Suicide 31

Introduction, Nosology, and History. William W. Eaton, PhD Johns Hopkins University

Introduction, Nosology, and History. William W. Eaton, PhD Johns Hopkins University This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike License. Your use of this material constitutes acceptance of that license and the conditions of use of materials on this