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Ask the Mental Health Expert Archives 2001-2004

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The Rise of Depression

Q. I am a student at UM-Columbia and am doing a study correlating consumer capitalism and the rise of depression. Could you help me locate some charts of depression rates over time for argumentative support?

A. That's a very interesting premise--maybe a modern version of the old saying, "Money is the root of all evil"? One problem is that depression is a very broad construct, and has been measured and diagnosed in different ways over the last 50 years. These methods have differed not only over time, but across national boundaries, so that somebody diagnosed as depressed in Hungary in 1944 might not be the equivalent of someone given the same diagnosis in New York in 1998.

Prevalence rates are also influenced by age and gender. Speaking of Hungary, you may be interested in the study by Kopp et al, in Budapest (Soc Sci Med 2000 Nov;51(9):1351-61). These researchers analyzed the interaction of social, economic, psychological and self-rated health characteristics of the Hungarian population during a period of sudden political-economic changes (1988-95). Age-dependent changes were observed between 1988 and 1995, with increasing depressive symptoms, hopelessness, and lack of control over working situation in the population above 40 years of age.

In contrast, in the younger population, improvements in depressive symptomatology could be seen. Depressive symptomatology was closely connected with hostility, low control in working situation, and low perceived social support. (For more information, try contacting Dr. Kopp at kopmar@net.sote.hu).

But what about other countries? There is a popular view that depression has been increasing worldwide, over the last 50 years--a view suggested in some studies, but not others. For example, in the Stirling County Study of adults from a population in Atlantic Canada, three samples over a 40-year period (1952, 1970, and 1992) showed a stable prevalence of depression (Murphy et al, Arch Gen Psychiatry 2000 Mar;57(3):209-15). However, this same group of researchers (Psychol Med 2000 May;30(3):505-14) performed an analysis of "at risk" subgroups of the larger sample, and found evidence of increasing rates of depression among women born since WWII.

Probably the most convincing study showing increasing rates of depression is that of the Cross-National Collaborative Group (JAMA 1992 Dec 2;268(21):3098-105). This was a massive study, involving approximately 39,000 in North America, Puerto Rico, Western Europe, the Middle East, Asia, and the Pacific Rim. The study found an increase in the cumulative lifetime rates of major depression with each successively younger birth cohort at all sites, with the exception of the Hispanic samples. As the authors note, "There are... variations in the long- and short-term trends for major depression by country, which suggests that the rates in these countries may have been affected by differing historical, social, economic, or biological environmental events."

Regarding your interest in capitalism, data from the classic Environmental Catchment Area (ECA) study (Regier, 1984) did not find an association between socio-economic status and major depression, though some data suggest a protective effect of employment on the risk of major depression. But as for consumer capitalism, who knows? Good luck with your research.

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May 2002

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