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Cross-national epidemiology of DSM-IV major depressive episode

Evelyn Bromet1*, Laura Helena Andrade2, Irving Hwang3, Nancy A Sampson3, Jordi Alonso4, Giovanni de Girolamo5, Ron de Graaf6, Koen Demyttenaere7, Chiyi Hu8, Noboru Iwata9, Aimee N Karam10, Jagdish Kaur11, Stanislav Kostyuchenko12, Jean-Pierre Lépine13, Daphna Levinson14, Herbert Matschinger15, Maria Elena Medina Mora16, Mark Oakley Browne17, Jose Posada-Villa18, Maria Carmen Viana19, David R Williams20 and Ronald C Kessler3

Author affiliations

1 Department of Psychiatry, State University of New York at Stony Brook, Putnam Hall - South Campus, Stony Brook, NY 11794-8790, NY, USA

2 Section of Psychiatric Epidemiology - LIM 23, Institute of Psychiatry, University of São Paulo Medical School, Sãu Paulo, Brazil

3 Department of Health Care Policy, Harvard Medical School, Boston, MA

4 Health Services Research Unit, IMIM (Hospital del Mar Research Institute), Barcelona, Spain and CIBER en Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain

5 IRCCS Centro S. Giovanni di Dio Fatebenefratelli, Brescia, Italy

6 Netherlands Institute of Mental Health and Addiction, Utrecht, The Netherlands

7 Department of Psychiatry, University Hospital Gasthuisberg, Leuven, Belgium

8 Shenzhen Institute of Mental Health & Shenzhen Kangning Hospital, Shenzhen, China

9 Department of Clinical Psychology, Hiroshima International University, Higashi-Hiroshima, Japan

10 Department of Psychiatry and Clinical Psychology, Saint George Hospital University Medical Center, Balamand University Medical School and the Institute for Development, Research, Advocacy and Applied Care (IDRAAC), Beirut, Lebanon

11 Directorate General of Health Services, New Delhi, India

12 Ukrainian Psychiatric Association, Kiev, Ukraine

13 Hôpital Lariboisière Fernand Widal, Assistance Publique Hôpitaux de Paris INSERM U 705, CNRS UMR 7157 University Paris Diderot and Paris Descartes Paris, France

14 Research & Planning, Mental Health Services Ministry of Health, Jerusalem, Israel

15 Institute of Social Medicine, Occupational Health and Public Health University of Leipzig, Leipzig, Germany

16 National Institute of Psychiatry, Mexico City, Mexico

17 The University of Tasmania Statewide and Clinical Director Dept of Health and Human Services New Town, Tasmania, Australia

18 Instituto Colombiano del Sistema Nervioso, Bogota D.C., Colombia

19 Section of Psychiatric Epidemiology, Institute of Psychiatry, School of Medicine, University of São Paulo, São Paulo, Brazil

20 Department of Society, Human Development and Health, Harvard School of Public Health, Boston, MA, USA

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Citation and License

BMC Medicine 2011, 9:90  doi:10.1186/1741-7015-9-90

Published: 26 July 2011



Major depression is one of the leading causes of disability worldwide, yet epidemiologic data are not available for many countries, particularly low- to middle-income countries. In this paper, we present data on the prevalence, impairment and demographic correlates of depression from 18 high and low- to middle-income countries in the World Mental Health Survey Initiative.


Major depressive episodes (MDE) as defined by the Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DMS-IV) were evaluated in face-to-face interviews using the World Health Organization Composite International Diagnostic Interview (CIDI). Data from 18 countries were analyzed in this report (n = 89,037). All countries surveyed representative, population-based samples of adults.


The average lifetime and 12-month prevalence estimates of DSM-IV MDE were 14.6% and 5.5% in the ten high-income and 11.1% and 5.9% in the eight low- to middle-income countries. The average age of onset ascertained retrospectively was 25.7 in the high-income and 24.0 in low- to middle-income countries. Functional impairment was associated with recency of MDE. The female: male ratio was about 2:1. In high-income countries, younger age was associated with higher 12-month prevalence; by contrast, in several low- to middle-income countries, older age was associated with greater likelihood of MDE. The strongest demographic correlate in high-income countries was being separated from a partner, and in low- to middle-income countries, was being divorced or widowed.


MDE is a significant public-health concern across all regions of the world and is strongly linked to social conditions. Future research is needed to investigate the combination of demographic risk factors that are most strongly associated with MDE in the specific countries included in the WMH.