하기 작성된 내용들은 Coursera의 Major Depression in the Population: A Public Health Approach (by JOHNS HOPKINS UNIVERSITY)의 강의 자료와 내용을 정리한 것입니다. 무단 공유 및 배포를 금합니다.
1A. What is Depression?
Major Depressive Episode (MDE): Diagnostic Criteria
- At least one of the following three abnormal moods significantly interfered with person's life:
- Abnormal depressed mood most of the day, nearly every day, for at least two weeks (dysphoria)
- Abnormal loss of all interest and pleasure most of the day, nearly every day, for at least two weeks (anhedonia)
- If 18 or younger, abnormal irritable mood most of the day, nearly every day, for at least two weeks
- At least five of the following symptoms have been present during the same two-week depressed period.
- Depressed mood (criterion A, above)
- Loss of all interest and pleasure (criterion B, above)
- Appetite or weight disturbance
- Sleep disturbance
- Agitation or slowing
- Fatigue or loss of energy
- Abnormal inappropriate guilt
- Poor concentration
- Thoughts of death or suicide
- Major depressive disorder is a syndrome including depressed mood, but also including eight other possible signs and symptoms: Depression, the mood, is not the same as Major Depression, the Disorder.
- The symptoms are not due to a mood-incongruent psychosis.
- There has never been a manic episode, a mixed episode, or a hypomanic episode.
- The symptoms are not due to physical illness, alcohol, medication, or street drugs.
- The symptoms are not due to normal bereavement.
Two major sources for depressive disorder
- Inheritance
- Stress/Loss
1B. Prevalence and Incidence of Major Depressive Episode (MDE)
Estimating Prevalence and Incidence
- Prevalence: the proportion in the population with the illness, e.g., a percentage (burden)
- Define and count the population denominator
- Count cases for the numerator from that defined population
- Incidence: the rate at which new cases form in the population, e.g. rate per time (force of morbidity)
- Define the population
- Define the cohort (risk set) who have never had the disorder
- Define the time period for follow-up
- Count the number of person-years for the denominator
- Count the number of new cases for the numerator
Prevalence of Major Depression in 12 months prior to interview
Life course of the incidence of Major Depression
- The peak incidence for females is earlier than for males
- The incidence rate for females is about twice as high as for males
1C. The Natural History of Major Depressive Disorder
The Natural History of Depression
- Prodrome is the period after the disease has begun before it is diagnosed.
- Onset is the beginning of the first episode.
- Remission is the end of the symptoms in an episode.
- Recovery occurs when a year has passed without another episode.
- Recurrence is the start of a later episode after recovery.
DIS/DSM-III Major Depressive Disorder
Symptomatic Course of Depressive Disorder
- Prodrome can be decades-long
- Episodes last several months
- About 50% of all lifetime cases have only one episode.
- About 15% of all lifetime cases are unremitting.
- About 35% of all lifetime cases have a relapsing and remitting course.
Gender Is Associated With Prevalence of Major Depressive Disorder, But Not With Bipolar Disorder
Gender Affects Incidence But Not Recurrence and Duration
1D. Major Depressive Disorder and Medical Conditions
Predictors of Non-Insulin Dependent Diabetes Onset: Baltimore ECA Follow-Up
Depression & Medical Conditions: Baltimore ECA Follow-up
1E. Estimating the Burden of Major Depressive Disorder and Medical Conditions
Estimating the Burden of Disease–Disability Weights
- Choose a prevention program that would improve the life of a healthy person by one year;
- How many years would that program have to extend life of a depressed person to be worth the same investment?
- Disability weight of 0.0 = healthy person
- Disability weight of 1.0 = death
- Disability weight of 0.5 = disability weight indicating the prevention program would have to extend life for two years
- Disability weights:
- Quadriplegia: 0.90
- Blindness: 0.62
- Deafness: 0.33
- Major Depressive Disorder (moderate): 0.35
