DISTRIBUTION OF PSYCHIATRIC DISORDERS IN GENERAL POPULATIONS
Psychiatric Epidemiology Unit, Massachusetts General Hospital
Jane M. Murphy, Ph.D., Richard R. Monson, M.D., Nan M. Laird, Ph.D., Andrew Nierenberg, M.D., Shari Bassuk, D.Sc., Nichols Horton, D.Sc., Alexander H. Leighton, M.D.
This project, known as the Stirling County Study, has built a 40-year data base in order to examine the distribution, frequency, and outcome of psychiatric disorders among 4000 sample members in a general population of Atlantic Canada. Comparative information is provided by cross-sectional studies of an urban area in the United States and of cross-cultural sites in other parts of the world. Data have been gathered by means of structured interviews with subjects and semi-structured interviews with general physicians about the same subjects. All categories of psychiatric disorders are included but most analyses focus on three common types of disorders: depression (major depression and dysthymia); anxiety (panic and generalized anxiety); and alcohol-abuse. The design of the study consists of repeated cross-sectional surveys and panel follow-up investigations. Some of the key findings about depression are as follows. Over the 40 years the prevalence of depression remained stable at about 5% of the adult population, a figure that has been replicated in most North American studies. Over the same period of time, the incidence of depression (first-ever cases emerging in a typical year) also remained stable. However, a birth cohort effect for women was discerned in that those born after the Second World War had a higher rate of depression. This supports information from other studies but does so without having to rely on retrospective reconstruction. The outcome of depression as measured by chronicity, recurrence, or association with mortality was worse for men than for women. Among people in the low socioeconomic status, depression was much more common than among those at the top. In a general population such as this, self-disparagement (feeling down on oneself) is a significant forerunner of a full-scale clinical depression.
Key Words: psychiatric epidemiology, general population, time trends, natural history of illness, mortality risk.
Grant Support. NIMH: R01 MH39576-17, A Longitudinal Study in Psychiatric Epidemiology (J.M.Murphy P.I.)
Project Sites: Primary site is the Psychiatric Epidemiology Unit, Massachusetts General Hospital; Collaborative sites are: the Department of Epidemiology, Harvard School of Public Health; Departments of Psychiatry and of Community Health and Epidemiology, Faculty of Medicine, Dalhousie University.
Project Director: Jane M. Murphy, Ph.D., Chief: Psychiatric Epidemiology Unit, Massachusetts General Hospital, 149 13th Street, Charlestown, MA 02129. Telephone: 617-726-1822, FAX 617-724-8301.
Training Opportunities: This program provides opportunities for trainees in population-based epidemiology, clinical epidemiology, biostatistical applications, clinical appraisal, and risk factor research.
Representative Publications.
Murphy JM, Monson RR, Laird NM, Sobol AM, Leighton AH: Identifying depression in a forty year epidemiologic investigation: the Stirling County Study. Int J Methods in Psychiatric Research. 1998;7:89-109.
Murphy JM, Monson RR, Laird NM, Sobol AM, Leighton AH: A forty-year perspective on the prevalence of depression from the Stirling County Study. Arch Gen Psychiatry. 2000;57:209-215.
Murphy JM, Monson RR, Laird NM, Sobol AM, Leighton AH: A comparison of diagnostic interviews for depression in the Stirling County Study: challenges for psychiatric epidemiology. Arch Gen Psychiatry. 2000;57:230-236.
Murphy JM, Laird NM, Monson RR, Sobol AM, Leighton AH: Incidence of depression in the Stirling County Study: historical and comparative perspectives. Psychol Med. 2000;30:505-514.
Murphy JM, Nierenberg AA, Monson RR, Laird NM, Sobol AM, Leighton AH: Self-Disparagement as Feature and Forerunner of Depression: Findings from the Stirling County Study. Comprehensive Psychiatry. 2001 (in press).