J Korean Med Sci.  2013 Feb;28(2):280-286. 10.3346/jkms.2013.28.2.280.

Prevalence, Work-Loss Days and Quality of Life of Community Dwelling Subjects with Depressive Symptoms

• Sohn JH
• Ahn SH
• Seong SJ
• Ryu JM
• Cho MJ

• KMID: 1429201
• DOI: http://doi.org/10.3346/jkms.2013.28.2.280

Abstract

The nationwide prevalence of major depressive disorder in Korea is lower than most countries, despite the high suicide rate. To explain this unexpectedly low prevalence, we examined the functional disability and quality of life in community-dwelling subjects with significant depressive symptoms not diagnosable as depressive disorder. A total of 1,029 subjects, randomly chosen from catchment areas, were interviewed with the Center for Epidemiologic Studies Depression scale, Mini International Neuropsychiatric Interview, WHO Quality of Life scale, and the WHO Disability Assessment Schedule. Those with scores over 21 on the depression scale were interviewed by a psychiatrist for diagnostic confirmation. Among community-dwelling subjects, the 1-month prevalence of major depressive disorder was 2.2%, but the 1-month prevalence of depressive symptoms not diagnosable as depressive disorder was 14.1%. Depressive disorders were the cause of 24.7% of work loss days, while depressive symptoms not diagnosable as depressive disorder were the cause of 17.2% of work loss days. These findings support the dimensional or spectrum approach to depressive disorder in the community and might be the missing link between the apparent low prevalence of depressive disorder and high suicide rate in Korea.

Keyword

Depression; Depressive Disorder, Major; Prevalence; Quality of Life; Mental Health

MeSH Terms

Adolescent
Adult
Analysis of Variance
Depression/*diagnosis/epidemiology
Female
Humans
Interviews as Topic
Male
Mental Health
Middle Aged
Prevalence
*Quality of Life
Young Adult

Figure

• 

  Fig. 1 Quality of life (QOL) and work-loss days according to subjects' depressive status; QOL, WHO Quality of Life scale scores; *not DSM-IV major depressive/dysthymic disorder but scored over 21 on CES-D; †DSM-IV diagnosed major depressive/dysthymic disorder.

Reference

1. Sohn JH, Cho MJ, Lee JY, Choi JH, Lee HW, Jeon HJ, Hahm BJ, Chang SM. Impact of mental disorders on functional disability: effect of non-psychotic common mental disorders on work loss days. J Korean Neuropsychiatr Assoc. 2008. 47:81–87.

2. Cho SJ, Lee JY, Hong JP, Lee HB, Cho MJ, Hahm BJ. Mental health service use in a nationwide sample of Korean adults. Soc Psychiatry Psychiatr Epidemiol. 2009. 44:943–951.

3. Cho MJ, Chang SM, Lee YM, Bae A, Ahn JH, Son J, Hong JP, Bae JN, Lee DW, Cho SJ, et al. Prevalence of DSM-IV major mental disorders among Korean adults: A 2006 National Epidemiologic Survey (KECA-R). Asian J Psychiatr. 2010. 3:26–30.

4. Cho MJ, Kim JK, Jeon HJ, Suh T, Chung IW, Hong JP, Bae JN, Lee DW, Park JI, Cho SJ, et al. Lifetime and 12-month prevalence of DSM-IV psychiatric disorders among Korean adults. J Nerv Ment Dis. 2007. 195:203–210.

5. Cho MJ, Hahm BJ, Suh DW, Hong JP, Bae JN, Kim JK, Lee DW, Cho SJ. Development of a Korean version of the composite international diagnostic interview (K-CIDI). J Korean Neuropsychiatr Assoc. 2002. 41:123–137.

6. Bromet E, Andrade LH, Hwang I, Sampson NA, Alonso J, de Girolamo G, de Graaf R, Demyttenaere K, Hu C, Iwata N, et al. Cross-national epidemiology of DSM-IV major depressive episode. BMC Med. 2011. 9:90.

7. Cho MJ, Lee JY, Kim BS, Lee HW, Sohn JH. Prevalence of the major mental disorders among the Korean elderly. J Korean Med Sci. 2011. 26:1–10.

8. OECD. OECD Factbook 2011-2012: Economic, Environmental and Social Statistics. 2012. Paris: OECD Publishing;270–271.

9. Zhang J, Ma J, Jia C, Sun J, Guo X, Xu A, Li W. Economic growth and suicide rate changes: a case in China from 1982 to 2005. Eur Psychiatry. 2010. 25:159–163.

10. Goldberg D. Plato versus Aristotle: categorical and dimensional models for common mental disorders. Compr Psychiatry. 2000. 41:8–13.

11. Cho MJ, Nam JJ, Suh GH. Prevalence of symptoms of depression in a nationwide sample of Korean adults. Psychiatry Res. 1998. 81:341–352.

12. WHO. The World health report: 2001: Mental health: new understanding, new hope. 2001. Geneva: World Health Organization.

13. Cuijpers P, Smit F. Subthreshold depression as a risk indicator for major depressive disorder: a systematic review of prospective studies. Acta Psychiatr Scand. 2004. 109:325–331.

14. Judd LL, Schettler PJ, Akiskal HS. The prevalence, clinical relevance, and public health significance of subthreshold depressions. Psychiatr Clin North Am. 2002. 25:685–698.

15. Solomon A, Haaga DA, Arnow BA. Is clinical depression distinct from subthreshold depressive symptoms? A review of the continuity issue in depression research. J Nerv Ment Dis. 2001. 189:498–506.

16. Angst J, Sellaro R, Merikangas KR. Depressive spectrum diagnoses. Compr Psychiatry. 2000. 41:39–47.

17. Radloff LS. The CES-D scale: a self-report depression scale for research in the general population. Appl Psychol Meas. 1977. 1:385–401.

18. Cho MJ, Kim KH. Use of the Center for Epidemiologic Studies Depression (CES-D) Scale in Korea. J Nerv Ment Dis. 1998. 186:304–310.

19. Sheehan DV, Lecrubier Y, Sheehan KH, Amorim P, Janavs J, Weiller E, Hergueta T, Baker R, Dunbar GC. The Mini-International Neuropsychiatric Interview (M.I.N.I.): the development and validation of a structured diagnostic psychiatric interview for DSM-IV and ICD-10. J Clin Psychiatry. 1998. 59:22–33.

20. Yoo SW, Kim YS, Noh JS, Oh KS, Kim CH, Namkoong K, Chai JH, Lee KC, Jeon SI, Min KJ, et al. Validity of the Korean version of the Mini International Neuropsychiatric Interview. Anxiety Mood. 2006. 2:50–55.

21. Min SK, Lee CI, Kim KI, Suh SY, Kim DK. Development of Korean Version of WHO Quality of Life Scale Abbreviated Version (WHOQOL-BREF). J Korean Neuropsychiatr Assoc. 2000. 39:571–579.

22. Yoon JS, Kim JM, Shin IS, Yang SJ, Zheng TJ, Lee HY. Development of Korean version of World Health Organization Disability Assessment Schedule II (WHODAS II-K) in community dwelling elders. J Korean Neuropsychiatr Assoc. 2004. 43:86–92.

23. Chang SM, Hong JP, Cho MJ. Economic burden of depression in South Korea. Soc Psychiatry Psychiatr Epidemiol. 2012. 47:683–689.

24. Alonso J, Angermeyer MC, Bernert S, Bruffaerts R, Brugha TS, Bryson H, de Girolamo G, Graaf R, Demyttenaere K, Gasquet I, et al. Disability and quality of life impact of mental disorders in Europe: results from the European Study of the Epidemiology of Mental Disorders (ESEMeD) project. Acta Psychiatr Scand Suppl. 2004. 38–46.

25. Chang SM, Hahm BJ, Lee JY, Shin MS, Jeon HJ, Hong JP, Lee HB, Lee DW, Cho MJ. Cross-national difference in the prevalence of depression caused by the diagnostic threshold. J Affect Disord. 2008. 106:159–167.

26. Rapaport MH, Judd LL. Minor depressive disorder and subsyndromal depressive symptoms: functional impairment and response to treatment. J Affect Disord. 1998. 48:227–232.

27. Gotlib IH, Lewinsohn PM, Seeley JR. Symptoms versus a diagnosis of depression: differences in psychosocial functioning. J Consult Clin Psychol. 1995. 63:90–100.

28. Klein DN, Shankman SA, Lewinsohn PM, Seeley JR. Subthreshold depressive disorder in adolescents: predictors of escalation to full-syndrome depressive disorders. J Am Acad Child Adolesc Psychiatry. 2009. 48:703–710.

29. Meeks TW, Vahia IV, Lavretsky H, Kulkarni G, Jeste DV. A tune in "a minor" can "b major": a review of epidemiology, illness course, and public health implications of subthreshold depression in older adults. J Affect Disord. 2011. 129:126–142.

30. Cho MJ, Moscicki EK, Narrow WE, Rae DS, Locke BZ, Regier DA. Concordance between two measures of depression in the Hispanic Health and Nutrition Examination Survey. Soc Psychiatry Psychiatr Epidemiol. 1993. 28:156–163.