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Welcome to Fireside Chat # January 22, 2012 1:00 – 2:30 PM Eastern Time CRDCN Major depression epidemiology: implications for health policy Dr. Scott B.

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Presentation on theme: "Welcome to Fireside Chat # January 22, 2012 1:00 – 2:30 PM Eastern Time CRDCN Major depression epidemiology: implications for health policy Dr. Scott B."— Presentation transcript:

1 Welcome to Fireside Chat # January 22, 2012 1:00 – 2:30 PM Eastern Time CRDCN Major depression epidemiology: implications for health policy Dr. Scott B. Patten Department of Community Health Sciences University of Calgary www.chnet-works.ca www.chnet-works.ca A project of Population Health Improvement Research Network University of Ottawa 1

2 (1) Definitions (2) What do we know about the epidemiology of depression? – Prevalence – Incidence – Duration of episodes (3) Implications for policy Outline 2

3 (1) Depressed mood (2) Loss of interest (3) Psychomotor changes (4) Diminished energy (5) Sleep disturbance (6) Appetite changes (7) Hopelessness, worthlessness (8) Diminished ability to think or concentrate (9) Thoughts of death/suicidal ideation Major Depressive Episode 3

4 (1) Needs to fit with the “general definition” of a mental disorder (2) Duration, distress, dysfunction, danger Major Depressive Episode 4

5 A Dimensional Characterization? “v-codes” Comp. Bereavement Adjustment Disorder MDD Chronic Depression “sub-threshold” “sub-syndromal” 5 1 st Episode / Recurrent

6 Prevalence of Major Depression Point Prevalence Period Prevalence Lifetime Prevalence 6

7 Point Prevalence (≈ 2%) 12-month Period Prevalence (≈ 5%) Lifetime Prevalence (≈ 12%) * Canadian Community Health - Survey, Mental Health and Wellbeing. Statistics Canada (2002). See: Patten SB, Wang JL, Williams JV, Currie S, Beck CA, Maxwell CJ et al.: Descriptive epidemiology of major depression in Canada. Can J Psychiatry 2006, 51: 84-90. 7 Prevalence of Major Depression

8 Digestive disorder (6%) Musculoskeletal disorders (4%) Endocrine (4%) Neuropsychiatric disorders (28%) Cancer (11%) Cardiovascular disease (22%) Sense organ impairment (10%) Other non-communicable diseases (7%) Respiratory disease (8%) Schizophrenia Bipolar disorder Dementia Substance-use and alcohol-use disorders Other mental disorders Epilepsy Other neurological disorders Other neuropsychiatric disorders Major depressive disorder 2% 10% 2% 4% 3% 1% 2% 3% Reproduced with permission. Prince M, et al. Lancet 2007;370:859-877 Depression: an underestimated and disabling condition Contribution (%) by different non-communicable diseases to disability-adjusted life-years worldwide in 2005 8

9 Policy Questions Does depression remain drastically undertreated? Should be screening in primary care? Is depression more like a chronic disease than an episodic acute disease? Are there secular trends/cohort effects? 9

10 The NPHS – A cohort (panel) study conducted by Statistics Canada – In 1994, a representative sample of n=17,262 respondents were selected – These have been re-interviewed every 2 years over the telephone – Response rate to 2006 estimated at 77% – The 2004 interview included “focus content” on depression – Each cycle includes the CIDI-SFMD 10

11 CCHS 1.2 National Sampling: Statistics Canada Cross-sectional Survey, 2002 N=36,000 Canadian Adaptation of the World Mental Health CIDI Note: A 2012 repeat of the national survey is coming soon! 11

12 Is Drastic Under Treatment? ically Undertreated? – NCS-R (Kessler et al. 2003): 21.6% receiving adequate treatment 1. – Analysis restricted to those with past 12-month episodes, and required 4 visits lasting at least 30 minutes to health care professionals for supervision of pharmacotherapy. 12 1 Kessler RC, Berglund P, Demler O, Jin R, Koretz D, Merikangas KR, et al. JAMA 2003;289:3095-105

13 Incidence & Lifetime Prevalence Source: Slomp M, Bland R, Patterson S, Whittaker L: Three-year physician treated prevalence rate of mental disorders in Alberta. Can J Psychiatry 2009, 54: 199-203. 13

14 Antidepressant Use 14 Simpson KR, Meadows GN, Frances AJ, Patten SB: Is mental health in the Canadian population changing over time? Can J Psychiatry 2012, 57: 324-331.

15 Depressive Episode Duration 15 Patten SB: A visual depiction of major depression epidemiology. BMC Psychiatry 2007, 7: 23.

16 Copyright restrictions may apply. Vos, T. et al. Arch Gen Psychiatry 2004;61:1097-1103. Depressive Episode Duration 16

17 Incidence & Lifetime Prevalence 17 Patten SB: Accumulation of major depressive episodes over time in a prospective study indicates that retrospectively assessed lifetime prevalence estimates are too low. BMC Psychiatry 2009, 9: 19.

18 Episode Characteristics (NPHS) 18 Patten SB, Williams JV, Lavorato DH, Bulloch AG, Macqueen G: Depressive episode characteristics and subsequent recurrence risk. J Affect Disord 2012, 140: 277-284.

19 Secular Trends & Cohort Effects 19

20 Cohort Effects (MDE)? 20 Simpson KR, Meadows GN, Frances AJ, Patten SB: Is mental health in the Canadian population changing over time? Can J Psychiatry 2012, 57: 324-331

21 What Don’t We Know: Policy Perspective Does depression remain drastically undertreated? Should be screening in primary care? Is depression more like a chronic disease than an episodic acute disease? Are there secular trends/cohort effects? 21 X X X X

22 Flexible Strategies are Needed B.C. Physician Support Program Alberta: Depression Clinical Pathways UK: Watchful Waiting (N.I.C.E.) US: Disease management strategies Canada: Shared Care Models 22

23 Canadian Research Data Centre Network 1)Improve data access by giving researchers across the country access to Statistics Canada confidential microdata and to an increasing range of administrative data 2)Expand the pool of skilled quantitative researchers 3)Make research count by improving communication between researchers and research users 23 www.rdc-cdr.ca

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