Preventing the Onset of Major Depression
Published in: Handbook of Depression / Edited by Gotlib IH, Hammen CL. (New York: Guilford Press, 2002), Chapter 14, p. 343-359
Posted on RAND.org on December 31, 2001
Depression is a major public health problem. In the United States, 17% of adults experience at least one episode of major depression during their lives (Kessler et al., 1994). The prevalence of major depression has been increasing since World War II in many countries. There is evidence that with each generation depression begins earlier and earlier (Kierman & Weissman, 1989). The World Health Organization reports that (1) major depression is the number one cause of disability in the world; and (2) in terms of the burden of disease in the world, taking into account both disability and mortality, major depression was the fourth most important disorder in 1990, and will become the second most important by the year 2020 (Murray & Lopez, 1996). When there is an epidemic of this type, treatment is not enough. It is necessary to dedicate a substantial portion of our resources to prevention. George Albee has said it well: John Gordon, a professor of epidemiology at Harvard in the late fifties, sat me down and said: No mass disorder afflicting humankind has ever been brought under control or eliminated by attempts at treating the afflicted individual nor by training large numbers of therapists. One does not get rid of mass plagues afflicting humankind, including the plague of mental and emotional disorders, by attempts at treating the individual. (1985, p. 213) Most mental health resources are currently dedicated to treatment. However, in the case of major depression, there are many serious limits to treatment. It reaches very few: of those meeting criteria for major depression in the United States, only 22% of non-Hispanic whites, and even fewer (I 1 %) Mexican Americans, receive mental health treatment (Hough et al., 1987). It is effective in only about two-thirds of those who adhere to treatment as directed (most do not) (Depression Guideline Panel, 1993a). Even if treatment is effective, the chances of the recurrence of a major depressive episode are 50% after one episode, 70% after two episodes, and 90% after three episodes (Depression Guideline Panel, 1993b; Judd, 1997). Therefore, preventing new episodes of major depression is essential. The ideal would be to prevent the first episode.