_______________________________________________________________________ Depression and Suicide
Depression is more common in persons with medical illnesses, with 11% to 36% of general medical inpatients fulfilling diag- nostic criteria for MDD [10; 11; 12; 13]. Depression also is two to three times more likely in individuals with chronic diseases, including diabetes, arthritis, and cardiovascular diseases [14]. According to data from the National Survey on Drug Use and Health (NSDUH), in 2021, an estimated 21 million Americans (8.3%) 18 years of age and older experienced a past-year major depressive episode, and 5 million (20.1%) American youth 12 to 17 years of age experienced a past-year major depressive episode [15]. DEMOGRAPHIC CHARACTERISTICS NSDUH data indicate that women have higher rates of depres- sion than men in every age group, with the highest rate occur- ring in individuals 26 to 49 years of age (11.1% in women; 7.5% in men) [15]. Rates of major depressive episodes among American Indian/Alaska Natives were 11.2%, compared with 8.4% among non-Hispanic White Americans [15]. Of the 21 million Americans 18 years of age and older who reported a past-year major depressive episode, approximately 15 mil- lion had episodes that included severe impairment. Of the 5 million young people 12 to 17 years of age who reported a past-year major depressive episode, approximately 3.6 million had episodes that included severe impairment. Female youth reported higher rates of severe impairment (22.1%) than male youths (7.8%) [15]. Social determinants of health (e.g., economic status, access to health care) also influence rates of depression [6]. Persons living below the poverty level are five times more likely to have current depression than those living at or above the poverty line [16]. Older Adults The rate of depression in adults older than 65 years of age ranges from 1% to 5% in the community but increases to 13.5% in those who require home healthcare and to 11.5% in the hospitalized elderly [17]. The recurrence rate of MDD in the elderly is also extremely high, at 40% [18]. Chronic health conditions contribute to an increased risk of depression in the elderly [17]. Peripartum Women The peripartum period may be the most common time in a woman’s life for depression to develop. Between 14% and 23% of women will experience a depressive disorder while pregnant, and 10% to 15% of women will experience a depressive disor- der postpartum [19; 20; 21]. Persistent Depressive Disorder Persistent depressive disorder in the fifth edition of the Diag- nostic and Statistical Manual of Mental Disorders (DSM-5-TR) represents a consolidation of DSM-IV-defined chronic MDD and dysthymic disorder. The 12-month prevalence in the United States is approximately 0.5% for persistent depressive disorder and 1.5% for chronic MDD [10]. The median age of onset of persistent depressive disorder is 31 years [22].
INTRODUCTION Depression is a common, debilitating mood disorder that is highly prevalent in medically ill populations, but many per- sons with depression are unaware they need, or are reluctant to seek, professional help. Primary care contact represents a potential opportunity for timely identification and interven- tion, but many patients with depression are inadequately diagnosed by non-psychiatrist clinicians, even after additional training [1; 2]. Even with accurate diagnosis, treatment is often inconsistent with current evidence, reflecting poor provider competence and confidence related to diagnosing and treating depression [3]. Adverse outcomes may result from treatment non-adherence, which can be positively influenced by patient preference for the prescribed modality and shared decision- making between physician and patient [4; 5]. Shortcomings in the delivery of care by primary care physicians, nurses, and behavioral health professionals represent an opportunity to alleviate patient distress and improve functioning through education. For some patients with major depressive disorder (MDD), their initial antidepressant is ineffective or intolerable, and others remain impaired despite substantial symptom reduc- tion. Inadequate patient outcomes may result from limitations in the foundation of clinical care for depression: MDD is a highly heterogeneous disorder but is diagnosed as a unitary syndrome, and almost all U.S. Food and Drug Administra- tion (FDA)-approved medications for depression are based on a 60-year-old mechanistic hypothesis. Knowledge advances are transforming the understanding and treatment of MDD. This course will discuss optimal use of standard diagnostic and therapeutic approaches, knowledge advances, and their consideration and integration into best practices of clinical care for patients with depression.
EPIDEMIOLOGY
INCIDENCE AND PREVALENCE OF DEPRESSION In 2020, 18.4% of U.S. adults (one in five) reported having ever been diagnosed with depression. The prevalence of depression was higher in women, younger adults, and adults with lower education levels. Estimates of an ever diagnosis of depression ranged from 12.7% in Hawaii to 27.5% in West Virginia. Age-standardized county-level prevalence estimates ranged from 10.7% to 31.9%, with considerable state- and county-level variability [6]. Reports that focused on measures of current depression (i.e., during the prior two weeks) rather than on lifetime depression showed similar subgroup differ- ences, including those observed both before and throughout the SARS-CoV-2 2019 (COVID-19) pandemic. Reporting from 2020 forward suggests that the COVID-19 pandemic contributed to a worsening mental health crisis in the United States, especially among adolescents and young adults [7; 8; 9].
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