Myrna M. Weissman

Affective disorders in five United States communities

Results on the age/sex specific prevalence of DSM-III affective disorders from the NIMH Epidemiologic Catchment Area Study (ECA), a probability sample of over 18,000 adults from five United States communities, are presented. The cross-site means for bipolar disorder ranged from 0.7/100 (2 weeks) to 1.2/100 (lifetime), with a mean age of onset of 21 years and no sex difference in rates. The cross-site means for major depression ranged from 1.5/100 (2 weeks) to 4.4/100 (lifetime), with a mean age onset of 27 years and higher rates in women. The cross-site means for dysthymia, a chronic condition, was 3.1/100 with a higher rate in women. There was reasonable consistency in prevalence rates among sites. The implications of these findings for understanding psychopathology are discussed.

The epidemiology of depression: An update on sex differences in rates

Data from the New Haven, CT, Standard Metropolitan Statistical Area, site of the NIMH Epidemiologic Catchment Area (ECA) study, a multi-site collaborative community survey of psychiatric disorders is presented. The 6-month prevalence rates based on the Diagnostic Interview Schedule (DIS) interview and the DSM-III found that major depression was more frequent in women than men (2.4:1). The sex ratios for bipolar disorder were about equal. The sex ratios for major depression were fairly consistent at different time periods retrospectively assessed. There appeared to be a birth cohort effect with cohorts born after 1936 having an earlier age of onset and higher rates of major depression but not a change in sex ratios. These findings must be considered in light of the methodologic limitations of retrospective recall.

Contact with health professionals for the treatment of psychiatric and emotional problems

This study focuses on predisposing, enabling, and need factors affecting contact with health professionals for the treatment of psychiatric and emotional problems during a 6-month period. Data are from the first wave of the Yale Epidemiologic Catchment Area (ECA) Project. The study confirms the important relationship of psychopathology to both the likelihood of using mental health related services and the quantity of service contacts. Sex, age, race, education, marital status, usual source of medical care, and attitudes toward mental health services were found to exert independent effects on the likelihood of contact with a health professional after controlling for clinical status. Factors affecting the quality of service contacts among utilizers were psychiatric status, usual source of care, and attitudes.

Rates and risks of depressive symptoms in a United States urban community

The results of a U.S. urban community survey, conducted in 1967 and in 1969, show that 16–18 % of the population have depressive symptoms at any one time. Similar rates are reported in five other studies where self‐report depression symptom scales have been used. The relationship between depressive symptoms and the diagnosis of major depressive disorders still requires investigation since the presence of depressive symptoms does not necessarily indicate the diagnosis of a major or minor depressive disorder.

Comorbidity and co-transmission of alcoholism, anxiety and depression

This paper applies data from a family study of depression to assess patterns of comorbidity and co-transmission of alcoholism, anxiety disorder, and major depression. We found that all three disorders were strongly transmissible; however, alcoholism demonstrated the greatest degree of familial aggregation. The pairwise associations among depression, anxiety and alcoholism indicated that the traits are co-transmitted in families, especially depression and anxiety. Individual associations between traits (or comorbidity) were entirely explained by transmitted (perhaps genetic) agents, because the correlations between traits due to random environment were not significant. These findings have important implications for treatment, psychiatric nosology, and aetiological investigations of these conditions.

Migraine and depression: Association and familial transmission

We have studied the association between migraine and major depression in a group of 133 probands with major depression, a group of 82 normal community controls and 400 interviewed first-degree relatives of the probands and controls. There was a significant association between depression and migraine among both the probands and the relatives. We also found that concomitant symptoms of anxiety were prominent among the depressed persons with migraine. Both depression and migraine were strongly familial but their association did not appear to be highly transmissible. Rather, our data suggested that depression may either be a sequela of migraine or the diathesis which results in both migraine and depression.

Children and depression: The children of depressed parents; The childhood of depressed patients; Depression in children

In order to understand the development of depression in children, three types of data are reviewed: (1) studies of the children of depressed parents; (2) studies of the childhood histories of depressed adults; (3) direct studies of depression in children. These data support an increased frequency of depression and other psychopathology in the children of depressed adults. An examination of the homes of children with a depressed parent reveals a disruptive, hostile, and rejecting environment. This atmosphere is also found in the homes of depressed children and in the homes of children who become depressed as adults. Methodological issues are discussed which will help sort out the relative influences of genes and environment in future studies.

Marital disputes and treatment outcome in depressed women.

Abstract This study assesses the relationship between improvement of marital disputes and other treatment outcomes. The subjects are 76 women who received 8 months of individual psychotherapy as part of a controlled clinical trial testing the efficacy of various outpatient maintenance treatments for depression. The presence or absence of marital disputes was rated at the beginning of treatment, and improvement or failure to improve was noted at the end of treatment. Three marital groups (no marital disputes, marital improvement, and no marital improvement) were compared in terms of symptom status and overall social adjustment at the beginning and end of treatment. The results reveal that depressed women with marital disputes at the onset of treatment have a generally poorer treatment outcome than women who are single or in supportive relationships. Only a minority of women with marital disputes effected an improvement in the relationship during the course of treatment. Those who improved their marriages also experienced an improvement in depressive symptoms, while those whose marriages did not improve experienced less improvement or a worsening of symptoms.

Lifetime prevalence and age of onset of psychiatric disorders: Recall 4 years later

The blind test-retest reliability of lifetime prevalence and age of onset of psychiatric diagnoses, based on the SADS-L interview and RDC over a three-to-five year period, was examined in 143 probands and their relatives. Reliability of lifetime prevalence of major depression was excellent; reliability of antisocial personality, panic disorder, drug abuse, GAD, depressive personality, and alcoholism was good; reliability of obsessive-compulsive disorder and phobia was acceptable but lower. The reliability of hyperthymia or cyclothymia was not acceptable. Reliability for major depression did not vary substantially by age or sex of the informant, but recall of major depression was significantly higher in the probands than in their relatives. The test-retest reliability for the age of onset of major depression and panic disorder was excellent, and for phobia, GAD and alcoholism, was acceptable. Both probands and relatives recalled the age of onset of their depression fairly accurately. However, there was a reduction in agreement over time. Recall after 3-4 yr was better than 5-6 yr. There was a tendency for older respondents to systematically increase the age of onset of their depression across the two interviews, although the increase was only a few years. Recall of age of onset did not differ significantly by sex of respondent or whether the respondent was a proband or relative. These findings are discussed in light of several available studies of reliability of lifetime prevalence of psychiatric diagnoses.

SOCIAL IMPAIRMENTS FOUR YEARS AFTER AN ACUTE DEPRESSIVE EPISODE

Social functioning of 40 depressed women was studied four years following the acute episode, and compared with 40 normal community subjects. Results show that the social impairments of depressed patients persist well beyond the acute episode, particularly in marital and close interpersonal relations. Clinical and public health implications are discussed.