Major Depressive Disorder MDD Depression is a chronic recurring and progressive disorder affecting 300350 million people worldwide 12 Depression is a highly prevalent disorder The percentage of people suffering from MDD worldwide was ID: 716442
Download Presentation The PPT/PDF document "Epidemiology and Burden" is the property of its rightful owner. Permission is granted to download and print the materials on this web site for personal, non-commercial use only, and to display it on your personal computer provided you do not modify the materials and that you retain all copyright notices contained in the materials. By downloading content from our website, you accept the terms of this agreement.
Slide1
Epidemiology and Burden
Major Depressive
Disorder
(MDD)Slide2
Depression is a chronic, recurring, and progressive disorder affecting
300-350 million
people worldwide
1,2
Depression is a highly prevalent disorder
The percentage of people suffering from MDD worldwide was 4.4% (4.1–4.7%) in 2010.2The prevalence of MDD remained very consistent between 1990 (4.4% (95% uncertainty: 4.2–4.7%)), 2005 (4.4% (4.1–4.7%) and 2010.Prevalence in 2010 was higher in females at 5.5% (5.0–6.0%) compared to males at 3.2% (3.0–3.6%). 2Across the lifespan, prevalence of MDD increases steadily between 3 and 19 years; peaks between 20 and 64 years; decreased between 65 to 74 years.
(1) Depression. Factsheet no. 369. Available at: http://www.who.int/mediacentre/factsheets/fs369/en/. Accessed April 2016. (2) Ferrari AJ, et al. 2010. PLoS One. 2013a;8(7):e69637
Slide3
It is estimated that each year, 6.9% of the EU population suffers from MDD
1
Depression is a highly prevalent disorder
(1)
Wittchen
HU et al. Eur Neuropsychopharmacol 2011;21:655-79; (2) Hasin DS et al. Arch Gen Psychiatry 2005;62:1097-106; (3) Kessler RC et al. Arch Gen Psychiatry 2005;62:593-602; (4) Bromet E et al. BMC Med 2011;9:90Mean lifetime prevalence of major depressive episode4The lifetime prevalence of MDD is
6.5–21%, depending on the country
2-4
MDD
6.5 – 21 %
USA
19%
Mexico
8%
Colombia
13%
5–10%
>10–15%
>15–20%
>20%
Brazil
18.8%
South
Africa
9.7%
India
9%
Shenzen
, China
7%
Japan9.8%
New Zealand7%
Ukraine14.5%
Lebanon11.2%
Israel10%
Italy9.8%
Spain11%
France21%
Belgium14%
Netherlands18.5%
Germany9.8%
*Total
high
income
countries
= 14.6%; total
low
to
middle
income
countries
= 11.1%
Only data for
countries
in the WHO
study
are
presentedSlide4
12 month prevelance
of mental
disorders
in Europe in 2011#Wittchen, H.-U. et al, 2011. Eur. Neuropsychopharmacology (2011) 21, 655–679
#
Prevalence ”best estimate”, conducted in EU-27 countries, plus Iceland, Norway and Switzerland* More details available in the speaker notes
12-month
prevalence
in
percent
(
no
.
persons
affected
)Slide5
Burden of Major Depressive Disorder
(MDD)Slide6
“Depression is the leading cause of disability worldwide, and is a major contributor to the overall global burden of disease”
WHO Fact Sheet No. 369 - Reviewed April 2016Slide7
MDD is a leading cause of burden
MDD has a worldwide prevalence estimate of 4.4%
1
MDD is the second leading cause of years lived with disability (YLDs)2The Global Burden of Disease Study 2010 found that MDD accounted for 8.2% of global YLDsUnipolar depressive disorders are predicted to become the leading cause of burden (DALYs) by 20303(1) Ferrari AJ, et al. 2010. PLoS One. 2013;8(7):e69637; (2) Ferrari et al. PLoS Med 2013;10(11):e1001547; (3)
WHO. Global burden of mental disorders and the need for a comprehensive, coordinated response from health and social sectors at the country level. 2011. Retrieved from: http://apps.who.int/gb/ebwha/pdf_files/EB130/B130_9-en.pdf. Accessed April 2016
; (4) Vos et al. Lancet 2012; 380: 2163–2196.DisorderRankLower back pain1
Major depressive disorder2
Iron-deficiency anaemia
3
Neck pain
4
COPD
5
Other musculoskeletal disorders
6
Anxiety disorders
7
Migraine
8
Diabetes
9Falls
10
Ten leading causes of YLDs worldwide, Global Burden of Disease Study 20104
COPD=chronic obstructive pulmonary disease
DALY=disability-adjusted life-yearSlide8
Contribution of Non-communicable
diseases
disability-adjusted life yearsPrince et al. Lancet 2007; 370: 859–877
By 2013, depression is projected to be the largest contributor to the global burden of disease
1Dis = Disorder/s; Neurol = Neurologic; Neuropsych = NeuropsychiatricSlide9
The burden associated with depression is large and increasing
(1)
Ratnasingham
S et al. Opening Eyes, Opening Minds: The Ontario Burden of Mental Illness and Addictions Report. Institute for Clinical Evaluative Sciences and Public Health Ontario, 2012; (2) Wittchen HU et al. Eur Neuropsychopharmacol 2011;21:655-79
Years of reduced function
Years of life lost
In terms of disability-adjusted life-years lost, depression is the most burdensome disorder of all brain diseases in the EU
2
Health-adjusted life years (HALYs)
- A combination of years lived with less than full function and years lost to early death.
1
YearsSlide10
Depression is the most burdensome disorder of all brain diseases in the EU
2)
Wittchen
HU et al. Eur Neuropsychopharmacol 2011;21:655-79
Rank
MenWomen Both
Diagnosis
Total DALYs*
Diagnosis
Total DALYs*
Diagnosis
Total DALYs*
1
Alcohol Use Disorders
1669k
Major Depression
2892k
Major Depression
4320k
2
Major Depression
1428k
Dementias
1477k
Dementias
2237k
3
Stroke
783k
Stroke
793k
Alcohol Use Disorders
2040k
4
Dementias
760k
Migraine
491k
Stroke
1577k
Rankings of DALY estimates (age 15+) by selected mental and neurological disorders for the EU-27 population
Major depression contributes 7.2% of the overall burden of disease in Europe, making it the number 1 contributor directly before Alzheimer's disease/dementia and alcohol use disorders.
* Total DALYs in
thousands
(k)
DALYs = disability-adjusted life-years lostSlide11
Depression is associated with poorer overall health scores than arthritis or diabetes and significantly adds to the burden of other chronic conditions
Depression has detrimental effects on overall health
Adapted from
Moussavi S, et al. Lancet. 2007;370:851-8.
100
80
60
40
20
0
Mean Health Score (0–100)
90.6
80.3
79.6
79.3
78.9
72.9
67.1
65.8
65.4
58.5
71.8
56.1
Depression adds to the burden of asthma, angina, arthritis, or diabetes
No chronic condition
Asthma only
Angina only
Arthritis only
Diabetes only
Depression only
Depression and arthritis
Depression and angina
Depression and asthma
Depression and diabetes
≥2 chronic conditions
Depression and
≥2 chronic conditionsSlide12
Depression is associated with significant personal and societal consequences
(1) American Psychiatric Association. Diagnostic and Statistical Manual of Mental Health Disorders. 5th ed. Washington, DC:
American Psychiatric Association; 2013; (2)
Krol M, et al. Pharmacoeconomics. 2011;29(7):601–19; (3) Marcus M, et al. 2012. http://www.who.int/mental_health/management/depression/who_paper_depression_wfmh_2012.pdf?ua=1 Accessed April 16, 2014.
The leading cause of psychiatric disability worldwide
2,31 in 20 people reported having an episode of depression in the previous year3
Decreased ability to interact with friends, family, and colleagues
1,3
High morbidity and mortality
2,3
3,000 suicide deaths every day, worldwide
3
Severe economic burden for patients and society
2
Largely driven by workplace productivity losses
2Slide13
The personal burden of MDD can be significant and wide-ranging
1. Kessler RC.
Psychiatr
Clin North Am 2012;35(1):1–14. 2
Family
Physical healthFinancesWork performance
Marital dissatisfaction/discord and negative parenting behaviours
are strongly related to symptoms
of depression
1
Personal earnings and household income of people with MDD are substantially lower than those without depression
1
MDD is significantly associated with chronic physical disorders including arthritis, asthma, cancer, diabetes,
cardiovascular disease and pain
1
People with MDD have the highest number of days away from work of any physical or mental disorder
1Slide14
MDD has significant costs to society
(1) WHO. Global burden of mental disorders and the need for a comprehensive, coordinated response from health and social sectors at the country level. 2011. Retrieved from: http://apps.who.int/gb/ebwha/pdf_files/EB130/B130_9-en.pdf. Accessed April 2016; (2). WHO The Global Burden of Disease 2004 Update. http://www.who.int/healthinfo/global_burden_dis ease/2004_report_update/
en
/. Accessed April 2016. 3. Global Burden of Disease Study 2013 Collaborators. Lancet 2015;386(9995):743–800
98.7 million
4.3%2nd53%
1.4x
Predicted to be leading cause of disease burden by 2030
1
Leading cause of years lived with disability in 2013
3
Median percentage increase
in disability associated with depression 1990–2013
3
Estimated number of people with moderate or severe disability due to depression in 2004
2
Increased risk of mortality for people with depression compared with the general population
1
Percentage of the global burden of disease (DALYs) represented by depression in 2004
2Slide15
MDD has significant costs to society: EU
(1) Hughes S. MEP: Depression in the Workplace. http://www.enwhp.org/fileadmin/user_upload/pdf/Policy_recommendations_depression_at_the_workplace.pdf. Accessed July 2015
€ 92 billion*
50%
50%
>⅓
€ 54 billion*
Percentage of patients being treated for depression who take employment sick leave
1
Proportion of patients on employment sick leave taking over 26 weeks off work
1
Estimated costs of depression
1
Non-healthcare-related costs of depression in 2010 (e.g. loss of work productivity)
1
Percentage of the cost of depression comes from workplace absenteeism and presenteeism
1Slide16
Depression is associated with significant economic costs
(1) Collins PY, et al. Nature. 2011;475:27–30; (2)
Sobocki
P, et al. J Ment Health Policy Econ. 2006;9:87-98; (3) Stewart WF, et al. JAMA. 2003; 289: 3135-44; (4) World Health Organization. Available at: http://www.who.int/healthinfo/global_burden_disease/GBD_report_2004update_part4.pdf?ua = 1. Accessed June 2016 Major depression is the leading cause of global disease burden among mental, neurological and substance-use disorders1
The total annual cost of depression in Europe was estimated at €118 billion in 2004, which corresponds to a cost of €253 per inhabitant2$44 billion cost to US employers in 1 year3 DALY, disability-adjusted life-year;COPD, chronic obstructive pulmonary disease
Burden of disease (DALYs):
Leading causes in high-income countries
1. Major depressive
disorder
8,2% (10)
6,3% (7,7)
3,9% (4,8)
3,6% (4,4)
3,4% (4,2)
3,4% (4,2)
3,0% (3,7)
3,0% (3,7)
3,0% (3,6)
2,6% (3,1)
Percent of total
DALYs
(million
DALYs
)Slide17
Cost per patient of brain disorders in Europe in 2010#
Gustavsson
et al.,
Eur Neuropsychopharm (2011)21,718-779
Mood
Disorders** Mood disorders includes major depression and (prevalence 6.9%) and bipolar (prevalence 0.9%) PPP =
purchasing power
parity
Cost
per
patient
(€ PPP 2010)
#
27 EU countries plus Switzerland, Norway, and IcelandSlide18
Cost per per patient of mental disorders in Europe in 2010
#
Gustavsson
et al., Eur Neuropsychopharm (2011)21,718-779
Mood
Disorders** Mood disorders includes major depression and (prevalence 6.9%) and bipolar (prevalence 0.9%)
PPP = purchasing power
parity
Cost
per
patient
(€ PPP 2010)
#
27 EU countries plus Switzerland, Norway, and IcelandSlide19
Number of persons with disorders of the brain in Europe 2010#
Gustavsson
et al.,
Eur Neuropsychopharm (2011)21,718-779
Mood
Disorders*Number of
diagnoses in
million
*
Mood disorders includes major depression and (prevalence 6.9%) and bipolar (prevalence 0.9%)
#
27 EU countries plus Switzerland, Norway, and IcelandSlide20
Mood
disorders
bears the highest total costs of brain disorders in Europe 2010#Gustavsson et al., Eur Neuropsychopharm (2011)21,718-779
Mood
Disorders*
*
Mood disorders includes major depression and (prevalence 6.9%) and bipolar (prevalence 0.9%)
PPP =
purchasing
power
parity
Total
cost
per
disorder
(
million
€ PPP 2010)
#
27 EU countries plus Switzerland, Norway, and IcelandSlide21
Mood
disorders
bears the highest total costs of mental disorders in Europe 2010#Gustavsson et al., Eur Neuropsychopharm (2011)21,718-779
Mood
Disorders*
*
Mood disorders includes major depression and (prevalence 6.9%) and bipolar (prevalence 0.9%)
PPP =
purchasing
power
parity
Total
cost
per
disorder
(
million
€ PPP 2010)
#
27 EU countries plus Switzerland, Norway, and IcelandSlide22
Depressive symptoms persist during periods of remission and subsequent depressive episodes
Conradi HJ, et al.
Psychol
Med. 2011;41:1165–1174.
Lack of energy
Sleeping problemsWorthlessness/guilt
Eating problems
Psychomotor problems
Death ideations
Cognitive problems
57
Core symptoms: depressed mood/
diminished interest
1.00
0.80
0.60
0.40
0.20
Mean Proportion of Time DSM-IV Symptom Cluster Is Present
0.00
1
9
17
25
33
41
49
65
73
81
89
97
105
113
121
129
137
145
Weeks of Follow-up
Mean proportion of time symptoms are present during 3-year follow-up period (N=267)Slide23
Cognitive impairment is among the most common residual symptoms in MDD*
McClintock SM, et al. J
Clin
Psychopharmacol. 2011;31:180-6.
Persistent depressive symptoms in STAR*D responders
Symptoms present in patients with MDD who responded but did not remit (N=428) Slide24
Patients with cognitive symptoms of depression often have deficits in overall functioning
1,2
(1)
Marazziti D, et al. Eur J Pharmacol. 2010;626:83-86; (2) Millan MJ, et al. Nat Rev Drug Discov. 2012;11:141-168; (3) American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. Arlington, VA: APA 2013.
Cognitive deficits are clinically important
1,3ProcessingSpeedDeficits in almost every domain of cognitive functioning
2
Deficits associated with functional domains
2
Learning
Attention
Motor Skills
Verbal
knowledge
Non-Verbal
knowledge
Executive
Functioning
Working
Memory
Episodic
Memory
Work
Social
Interaction
Family LifeSlide25
Depression
costs
more to
employers than is spent on managing it
(1)
Olesen J, et al. Eur J Neurol. 2012;19:155–162. (2) Stewart WF, et al. JAMA. 2003;289(23):3135–3144. (3) Perkins M, Back A. Mental health failing costs business $11b. 2014. Retrieved from: http://www.smh.com.au/national/mental-healthfailing-costs-business-11b-20140519-38k5r.html. Accessed May 2015Direct medical costs of managing depression in the EU: €38 billion1Depression
costs for
employers
in
selected
regions:
€37 billion
in the US
2
€54 billion
in the EU
1
€7.5 billion
in Australia
3Slide26
Depression directly impacts working
time
IDEA: Impact of Depression at Work in Europe Audit Final report.
Ipsos Healthcare. October 2012.
One out of 10 people have taken time off work for depression
Taken an average of 36 days per period