Brief reportDisability and comorbidity among major depressive disorder and double depression in African–American adults
Introduction
Depression is the leading cause of disability worldwide and a major contributor to the global burden of disease (World Health Organization (WHO), 2013). Dysthymia is characterized by less severe depressive symptoms than major depressive disorder (MDD) (American Psychiatric Association, 2000). However, recent studies show dysthymia associated with comparable (Subodh et al., 2008) or more disability than MDD (Hellerstein et al., 2010, Rhebergen et al., 2010). Compared to MDD, dysthymia is more likely to have a comorbid anxiety disorder (Rhebergen et al., 2009), which may explain the higher rates of disability associated with dysthymia.
Many individuals with dysthymia develop concurrent MDD, a phenomenon called “double depression” (Keller and Shapiro, 1982). Compared to MDD, double depression is associated with more disability (Hellerstein et al., 2010). Double depression is also associated with more comorbid anxiety (Rhebergen et al., 2012, Sang et al., 2011), panic (Sang et al., 2011) and obsessive–compulsive disorders (Holm-Denoma et al., 2006), and agoraphobias (Sang et al., 2011, Holm-Denoma et al., 2006) which may explain the higher rates of disability in double depression compared to MDD. Double depression and dysthymia have similar disability and comorbidities (Hellerstein et al., 2010, Rhebergen et al., 2009). Few studies have examined differences in disability and comorbity among MDD, dysthymia and double depression and no depression in African–Americans (AA), which is the purpose of this study.
Section snippets
Study design and population
A secondary analysis was performed on the National Survey of American Life (NSAL). Heeringa et al. (2004) described a four stage national area probability sampling; (1) stratified probability sample of 1990 US census blocks households where <10% and ≥10% were reported to be AA, (2) area segments formed by linking geographically continuous census blocks, and (3) systematic random sample of housing units where an interviewer and (4) randomly selected a respondent from a complete list of eligible
Results
Dysthymia was endorsed by only 2 individuals and was eliminated from subsequent analyses. Women were more likely to endorse MDD and double depression than men. There was a statistically significant difference in income, with AA who endorsed double depression reporting lower incomes than non-depressed AA.
There was a statistically significant difference among the groups in the following disability domains: global, getting around, getting along with others, and life activities (Table 1). Compared
Discussion
The current study addresses the nosology of mood disorders in a large carefully characterized cohort of AA. This study investigated the extent to which AA with MDD, dysthymia, double depression and no depression could be distinguished from each other in terms of disability, and if comorbidities explained differences in disability.
AA who endorsed double depression reported similar disability with AA who endorsed MDD, which contradicts the literature (Hellerstein et al., 2010, Rhebergen et al.,
Role of funding source
This research was supported by grants from the National Institutes for Health (NIH), (U01MH057716 and 1F31NR010669). NIH the report, or de had no further role in study design; collection, analysis and interpretation of data; writing ofcision to submit the paper for publication. NIH had no further role in study design; collection, analysis and interpretation of data; writing of the report, or decision to submit the paper for publication.
Conflict of interest
The author declares no conflict of interest.
Acknowledgment
The author would like to thank Dr. Kathleen Buckwalter for her editorial comments.
References (22)
- et al.
Impairment in psychosocial functioning associated with dysthymic disorder in the NESARC study
Journal of Affective Disorders
(2010) - et al.
Double depression in adult psychiatric outpatients in Brazil: distinct from major depression?
Psychiatry Research
(2006) - et al.
Trajectories of recovery of social and physical functioning in major depression, dysthymic disorder and double depression: A 3-year follow-up
Journal of Affective Disorders
(2010) - et al.
The three-year naturalistic course of major depressive disorder, dysthymic disorder and double depression
Journal of Affective Disorders
(2009) - et al.
The categorisation of dysthymic disorder: can its constituents be meaningfully apportioned?
Journal of Affective Disorders
(2012) - et al.
A comparison of the clinical characteristics of Chinese patients with recurrent major depressive disorder with and without dysthymia
Journal of Affective Disorders
(2011) - et al.
Psychosocial impact of dysthymia: a study among married patients
Journal of Affective Disorders
(2008) - et al.
Modified WHODAS-II provides valid measure of global disability but filter items increased skewness
Journal of Clinical Epidemiology
(2008) Dysthymic disorder: psychopathology of proposed chronic depressive subtypes
American Journal of Psychiatry
(1983)Diagnostic and Statistical Manual of Mental Disorders: Text Revision DSM-IV-TR
(2000)
The state of knowledge of chronic depression
Journal of Clinical Psychiatry
Cited by (10)
Prevalence and related factors of anxiety in first episode and drug naïve Chinese Han outpatients with psychotic major depression
2022, Journal of Affective DisordersCitation Excerpt :In China, >70 % of MDD patients exhibited anxiety symptoms (Li et al., 2012; Wu et al., 2013; Xin et al., 2015). Compared with “pure depression patients”, MDD patients with comorbid anxiety typically have severe depression (Fava et al., 2004; Goldberg et al., 2014) and suicide risks (Dold et al., 2017; Oude Voshaar et al., 2016), greater functional impairment (Torres, 2013), less treatment response (Wiethoff et al., 2010), and higher recurrence rates (Gaspersz et al., 2018). These severe clinical outcomes highlight the need for timely early identification and treatment of anxiety in MDD.
A national study of the influence of adverse childhood experiences on depression among Black adults in the United States
2022, Journal of Affective DisordersCitation Excerpt :Approximately one-in-ten Black adults in the United States experience a major depressive episode annually (Hasin et al., 2018). Depression has been associated with comorbid medical conditions (Watkins et al., 2015) and disability among African Americans (Torres, 2013). While major depressive disorder is lower among African Americans and Caribbean Blacks than Whites, it is more severe and disabling in both groups (Williams et al., 2007).
Prevalence and clinical profiles of comorbid anxiety in first episode and drug naïve patients with major depressive disorder
2019, Journal of Affective DisordersCitation Excerpt :Major depressive disorder (MDD) and anxiety disorder are common coexisting psychiatric disorders (Fava et al., 2008; Kessler et al., 1997; Mathew et al., 2011). Compared to MDD without anxiety, MDD patients with anxiety were associated with more functional impairment (Deschênes et al., 2015; Torres, 2013), poorer quality of life, more considerable economic burden (Olesen et al., 2012; Wittchen et al., 2011), higher risk of illness severity(Cyranowski et al., 2012; Goldberg et al., 2014), suicidal behaviors (Cougle et al., 2009; Oude et al., 2016), and comorbid cardiovascular disease (Bruce et al., 2016; Frasure-Smith and Lesperance, 2008). Moreover, MDD patients with comorbid anxiety have poorer response to treatment, a longer course of illness, and experience less positive treatment outcomes when compared to MDD patient without anxiety (Gorman, 1996; Wiethoff et al., 2010).
Resilience for dropout students with depression in secondary schools in Hong Kong: parental attachment, hope and community integration
2020, Asia Pacific Journal of Social Work and DevelopmentWorld Health Organization disability assessment schedule 2.0: An international systematic review
2017, Disability and Rehabilitation