Journal of Korean Medical Science

Korean Acad Medical Sciences (대한의학회)
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Prevalence and Associated Factors of Depression in General Population of Korea: Results from the Korea National Health and Nutrition Examination Survey, 2014

  • Shin, Cheolmin (Department of Psychiatry, Korea University College of Medicine, Korea University Ansan Hospital) ;
  • Kim, Yoonjung (Division of Health and Nutrition Survey, Centers for Disease Control and Prevention) ;
  • Park, Suyeon (Division of Health and Nutrition Survey, Centers for Disease Control and Prevention) ;
  • Yoon, Seoyoung (Department of Psychiatry, Daegu Catholic University Medical Center) ;
  • Ko, Young-Hoon (Department of Psychiatry, Korea University College of Medicine, Korea University Ansan Hospital) ;
  • Kim, Yong-Ku (Department of Psychiatry, Korea University College of Medicine, Korea University Ansan Hospital) ;
  • Kim, Seung-Hyun (Department of Psychiatry, Korea University College of Medicine, Korea University Guro Hospital) ;
  • Jeon, Sang Won (Department of Psychiatry, Sungkyunkwan University School of Medicine) ;
  • Han, Changsu (Department of Psychiatry, Korea University College of Medicine, Korea University Ansan Hospital)
  • Received : 2017.06.13
  • Accepted : 2017.07.29
  • Published : 2017.11.10
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Abstract

Depressive disorder is a common mental illness and remains a major cause of morbidity worldwide. The present study, a cross-sectional, nationwide, population-based survey assessed the prevalence of depression in the general population of Korea through a random sampling of the non-institutionalized population for the Korea National Health and Nutrition Examination Survey (KNHANES) VI. The Patient Health Questionnaire (PHQ)-9 was first introduced into the KNHANES to detect depression. The point prevalence of depression (PHQ score of 10 or higher) was 6.7% (95% confidence interval [CI], 5.7-7.6) in 4,949 subjects. Based on the analysis using the diagnostic algorithm of the PHQ-9, the prevalence of major depressive disorder was 2.7% (95% CI, 2.2-3.3). Multiple logistic regression analysis, after adjusting the sociodemographic variables, also showed that the factors associated with depression were perceived stress and health status. This study reported for the first time that the point prevalence of depression screened using the PHQ-9 in this nationwide survey of the Korean population was similar to that of the western countries. As the KNHANES to detect depression is conducted biennially, further studies on the accumulated data are expected in the future.

Keywords

References

  1. Ferrari AJ, Charlson FJ, Norman RE, Patten SB, Freedman G, Murray CJ, Vos T, Whiteford HA. Burden of depressive disorders by country, sex, age, and year: findings from the global burden of disease study 2010. PLoS Med 2013; 10: e1001547. https://doi.org/10.1371/journal.pmed.1001547
  2. Maynard CK. Differentiate depression from dementia. Nurse Pract 2003; 28: 18-9. https://doi.org/10.1097/00006205-200303000-00005
  3. Hirschfeld RM, Keller MB, Panico S, Arons BS, Barlow D, Davidoff F, Endicott J, Froom J, Goldstein M, Gorman JM, et al. The National Depressive and Manic-Depressive Association consensus statement on the undertreatment of depression. JAMA 1997; 277: 333-40. https://doi.org/10.1001/jama.1997.03540280071036
  4. Alonso J, Angermeyer MC, Bernert S, Bruffaerts R, Brugha TS, Bryson H, de Girolamo G, Graaf R, Demyttenaere K, Gasquet I, et al. Prevalence of mental disorders in Europe: results from the European Study of the Epidemiology of Mental Disorders (ESEMeD) project. Acta Psychiatr Scand Suppl 2004: 21-7.
  5. Kessler RC, Berglund P, Demler O, Jin R, Koretz D, Merikangas KR, Rush AJ, Walters EE, Wang PS; National Comorbidity Survey Replication. The epidemiology of major depressive disorder: results from the National Comorbidity Survey Replication (NCS-R). JAMA 2003; 289: 3095-105. https://doi.org/10.1001/jama.289.23.3095
  6. Henderson S, Andrews G, Hall W. Australia's mental health: an overview of the general population survey. Aust N Z J Psychiatry 2000; 34: 197-205. https://doi.org/10.1080/j.1440-1614.2000.00686.x
  7. Liao SC, Chen WJ, Lee MB, Lung FW, Lai TJ, Liu CY, Lin CY, Yang MJ, Chen CC. Low prevalence of major depressive disorder in Taiwanese adults: possible explanations and implications. Psychol Med 2012; 42: 1227-37. https://doi.org/10.1017/S0033291711002364
  8. Chiu E. Epidemiology of depression in the Asia Pacific region. Australas Psychiatry 2004; 12 Suppl: S4-10. https://doi.org/10.1080/j.1039-8562.2004.02099.x-1
  9. Cho MJ, Nam JJ, Suh GH. Prevalence of symptoms of depression in a nationwide sample of Korean adults. Psychiatry Res 1998; 81: 341-52. https://doi.org/10.1016/S0165-1781(98)00122-X
  10. Cho MJ, Lee JY. Epidemiology of depressive disorders in Korea. Psychiatry Investig 2005; 2: 22-7.
  11. Cho MJ, Seong SJ, Park JE, Chung IW, Lee YM, Bae A, Ahn JH, Lee DW, Bae JN, Cho SJ, et al. Prevalence and correlates of DSM-IV mental disorders in South Korean adults: the Korean epidemiologic catchment area study 2011. Psychiatry Investig 2015; 12: 164-70. https://doi.org/10.4306/pi.2015.12.2.164
  12. Kroenke K, Spitzer RL, Williams JB. The PHQ-9: validity of a brief depression severity measure. J Gen Intern Med 2001; 16: 606-13. https://doi.org/10.1046/j.1525-1497.2001.016009606.x
  13. Lowe B, Unutzer J, Callahan CM, Perkins AJ, Kroenke K. Monitoring depression treatment outcomes with the patient health questionnaire-9. Med Care 2004; 42: 1194-201. https://doi.org/10.1097/00005650-200412000-00006
  14. Han C, Jo SA, Kwak JH, Pae CU, Steffens D, Jo I, Park MH. Validation of the Patient Health Questionnaire-9 Korean version in the elderly population: the Ansan Geriatric study. Compr Psychiatry 2008; 49: 218-23. https://doi.org/10.1016/j.comppsych.2007.08.006
  15. Kroenke K, Spitzer RL. The PHQ-9: a new depression diagnostic and severity measure. Psychiatr Ann 2002; 32: 509-15. https://doi.org/10.3928/0048-5713-20020901-06
  16. Rief W, Nanke A, Klaiberg A, Braehler E. Base rates for panic and depression according to the Brief Patient Health Questionnaire: a population-based study. J Affect Disord 2004; 82: 271-6. https://doi.org/10.1016/j.jad.2003.11.006
  17. Reeves WC, Strine TW, Pratt LA, Thompson W, Ahluwalia I, Dhingra SS, McKnight-Eily LR, Harrison L, D'Angelo DV, Williams L, et al. Mental illness surveillance among adults in the United States. MMWR Suppl 2011; 60: 1-29.
  18. Strine TW, Kroenke K, Dhingra S, Balluz LS, Gonzalez O, Berry JT, Mokdad AH. The associations between depression, health-related quality of life, social support, life satisfaction, and disability in community-dwelling US adults. J Nerv Ment Dis 2009; 197: 61-4. https://doi.org/10.1097/NMD.0b013e3181924ad8
  19. Kocalevent RD, Hinz A, Brahler E. Standardization of the depression screener patient health questionnaire (PHQ-9) in the general population. Gen Hosp Psychiatry 2013; 35: 551-5. https://doi.org/10.1016/j.genhosppsych.2013.04.006
  20. Maske UE, Busch MA, Jacobi F, Beesdo-Baum K, Seiffert I, Wittchen HU, Riedel-Heller S, Hapke U. Current major depressive syndrome measured with the Patient Health Questionnaire-9 (PHQ-9) and the Composite International Diagnostic Interview (CIDI): results from a cross-sectional population-based study of adults in Germany. BMC Psychiatry 2015; 15: 77. https://doi.org/10.1186/s12888-015-0463-4
  21. Wang W, Bian Q, Zhao Y, Li X, Wang W, Du J, Zhang G, Zhou Q, Zhao M. Reliability and validity of the Chinese version of the Patient Health Questionnaire (PHQ-9) in the general population. Gen Hosp Psychiatry 2014; 36: 539-44. https://doi.org/10.1016/j.genhosppsych.2014.05.021
  22. Yu X, Tam WW, Wong PT, Lam TH, Stewart SM. The Patient Health Questionnaire-9 for measuring depressive symptoms among the general population in Hong Kong. Compr Psychiatry 2012; 53: 95-102. https://doi.org/10.1016/j.comppsych.2010.11.002
  23. Kader Maideen SF, Sidik SM, Rampal L, Mukhtar F. Prevalence, associated factors and predictors of depression among adults in the community of Selangor, Malaysia. PLoS One 2014; 9: e95395. https://doi.org/10.1371/journal.pone.0095395
  24. Moussavi S, Chatterji S, Verdes E, Tandon A, Patel V, Ustun B. Depression, chronic diseases, and decrements in health: results from the World Health Surveys. Lancet 2007; 370: 851-8. https://doi.org/10.1016/S0140-6736(07)61415-9
  25. Ohayon MM, Hong SC. Prevalence of major depressive disorder in the general population of South Korea. J Psychiatr Res 2006; 40: 30-6. https://doi.org/10.1016/j.jpsychires.2005.02.003
  26. Yen IH, Kaplan GA. Poverty area residence and changes in depression and perceived health status: evidence from the Alameda County Study. Int J Epidemiol 1999; 28: 90-4. https://doi.org/10.1093/ije/28.1.90
  27. Beekman AT, Deeg DJ, van Tilburg T, Smit JH, Hooijer C, van Tilburg W. Major and minor depression in later life: a study of prevalence and risk factors. J Affect Disord 1995; 36: 65-75. https://doi.org/10.1016/0165-0327(95)00061-5
  28. Bergdahl J, Bergdahl M. Perceived stress in adults: prevalence and association of depression, anxiety and medication in a Swedish population. Stress Health 2002; 18: 235-41. https://doi.org/10.1002/smi.946
  29. de Wit LM, van Straten A, van Herten M, Penninx BW, Cuijpers P. Depression and body mass index, a u-shaped association. BMC Public Health 2009; 9: 14. https://doi.org/10.1186/1471-2458-9-14
  30. Kim JY, Chang HM, Cho JJ, Yoo SH, Kim SY. Relationship between obesity and depression in the Korean working population. J Korean Med Sci 2010; 25: 1560-7. https://doi.org/10.3346/jkms.2010.25.11.1560
  31. Manea L, Gilbody S, McMillan D. A diagnostic meta-analysis of the Patient Health Questionnaire-9 (PHQ-9) algorithm scoring method as a screen for depression. Gen Hosp Psychiatry 2015; 37: 67-75. https://doi.org/10.1016/j.genhosppsych.2014.09.009
  32. Simon GE, Fleck M, Lucas R, Bushnell DM; LIDO Group. Prevalence and predictors of depression treatment in an international primary care study. Am J Psychiatry 2004; 161: 1626-34. https://doi.org/10.1176/appi.ajp.161.9.1626
  33. Angermeyer MC, Matschinger H. Public attitudes to people with depression: have there been any changes over the last decade? J Affect Disord 2004; 83: 177-82. https://doi.org/10.1016/j.jad.2004.08.001
  34. Makowski AC, Mnich EE, Ludwig J, Daubmann A, Bock T, Lambert M, Harter M, Dirmaier J, Tlach L, Liebherz S, et al. Changes in beliefs and attitudes toward people with depression and schizophrenia - results of a public campaign in Germany. Psychiatry Res 2016; 237: 271-8. https://doi.org/10.1016/j.psychres.2016.01.029
  35. Simon GE, Rutter CM, Peterson D, Oliver M, Whiteside U, Operskalski B, Ludman EJ. Does response on the PHQ-9 Depression Questionnaire predict subsequent suicide attempt or suicide death? Psychiatr Serv 2013; 64: 1195-202. https://doi.org/10.1176/appi.ps.201200587
  36. Pinto-Meza A, Serrano-Blanco A, Penarrubia MT, Blanco E, Haro JM. Assessing depression in primary care with the PHQ-9: can it be carried out over the telephone? J Gen Intern Med 2005; 20: 738-42. https://doi.org/10.1111/j.1525-1497.2005.0144.x
  37. Martin A, Rief W, Klaiberg A, Braehler E. Validity of the Brief Patient Health Questionnaire Mood Scale (PHQ-9) in the general population. Gen Hosp Psychiatry 2006; 28: 71-7. https://doi.org/10.1016/j.genhosppsych.2005.07.003
  38. Moriarty AS, Gilbody S, McMillan D, Manea L. Screening and case finding for major depressive disorder using the Patient Health Questionnaire (PHQ-9): a meta-analysis. Gen Hosp Psychiatry 2015; 37: 567-76. https://doi.org/10.1016/j.genhosppsych.2015.06.012
  39. Huang FY, Chung H, Kroenke K, Delucchi KL, Spitzer RL. Using the Patient Health Questionnaire-9 to measure depression among racially and ethnically diverse primary care patients. J Gen Intern Med 2006; 21: 547-52. https://doi.org/10.1111/j.1525-1497.2006.00409.x
  40. Diez-Quevedo C, Rangil T, Sanchez-Planell L, Kroenke K, Spitzer RL. Validation and utility of the patient health questionnaire in diagnosing mental disorders in 1003 general hospital Spanish inpatients. Psychosom Med 2001; 63: 679-86. https://doi.org/10.1097/00006842-200107000-00021

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