A recent analysis determined that the Diagnostic and Statistical Manual of Mental Disorders-5 (DSM-5)-defined major depressive disorder (MDD) is not only a highly prevalent and disabling disease but is also left untreated in a substantial amount of patients.

To determine the prevalence of DSM-5 MDD as well as DSM-5 specifiers, the study authors conducted “in-person interviews with a representative sample of US noninstitutionalized civilian adults (≥18 years) (n = 36 309) who participated in the 2012-2013 National Epidemiologic Survey on Alcohol and Related Conditions III (NESARC-III).” Data collection occurred between April 2012 and June 2013 and was analyzed in 2016-2017.

The authors calculated the 12-month and lifetime prevalence of MDD as 10.4% and 20.6%, respectively. Significantly lower odds of 12-month MDD were observed in men (odds ratio [OR]: 0.5; 95% CI: 0.46, 0.55) as well as in African American (OR: 0.6; 95% CI: 0.54, 0.68), Asian/Pacific Islander (OR: 0.6; 95% CI: 0.45, 0.67), and Hispanic (OR: 0.7; 95% CI: 0.62, 0.78) adult patients compared to white adult patients. Additionally, odds of 12-month MDD were higher in 18- to 29-year-old patients (OR: 3.0; 95% CI: 2.48, 3.55) as well as in patients with incomes of $19,999 or less (OR: 1.7; 95% CI: 1.49, 2.04).  

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Data also revealed strong associations between MDD and psychiatric disorders, such as specific phobias (adjusted odds ratios [aOR]: 2.1; 95% CI: 1.84, 2.35) and generalized anxiety disorders (aOR: 5.7; 95% CI: 4.98, 6.50). Additionally, associations between MDD and substance use disorders were also observed (alcohol – aOR: 1.8; 95% CI: 1.63, 2.01; any drug – aOR: 3.0; 95% CI: 2.57, 3.55).

The study authors also reported that 39.7% of lifetime MDD cases were considered moderate in severity while 49.5% were considered severe. Treatment was obtained in nearly 70% of lifetime MDD cases. “Functioning among those with severe MDD was approximately 1 SD below the national mean,” the study authors explained. They added, “Among 12.9% of those with lifetime MDD, all episodes occurred just after the death of someone close and lasted less than 2 months.”

Results of the study also revealed that 74.6% of MDD cases were characterized as the anxious/distressed specifier, while 15.5% were characterized as the mixed-features specifier. The authors noted that both specifiers were correlated with early onset, decreased functioning, and suicidality when severity was controlled.

Results of this analysis determined that DSM-5 MDD is a highly prevalent and disabling condition. Although many patients receive treatment for MDD, a large number of patients are left untreated. The study authors conclude, “Much remains to be learned about the DSM-5 MDD specifiers in the general population.”


Hasin, D.S. et al. Epidemiology of Adult DSM-5 Major Depressive Disorder and its Speficiers in the United States. JAMA Psychiatry. 2018. DOI: 10.1001/jamapsychiatry.2017.4602.