Depressão unipolar em adultos - Epidemiologia

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Depressão unipolar em adultos: Epidemiologia
INTRODUÇÃO
A depressão é um importante problema de saúde pública associado ao aumento da
incapacidade funcional e da mortalidade. Nos Estados Unidos, em 2010, as consequências
económicas anuais estimadas da depressão unipolar major, incluindo custos médicos directos
e custos no local de trabalho, ultrapassaram os 200 mil milhões de dólares [ 1 ].
Este tópico revisa a epidemiologia da depressão unipolar em adultos. As características
clínicas, curso da doença, avaliação, diagnóstico e tratamento da depressão são discutidos
separadamente.
DEFINIÇÕES DE DEPRESSÃO
O termo “depressão” pode ser usado de diversas maneiras, o que pode ser confuso;
depressão pode se referir a um [ 2,3 ]:
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�������� ��������: Sara Swenson, médica, David Salomão, MD
Todos os tópicos são atualizados à medida que novas evidências são disponibilizadas e nosso processo de revisão por
pares é concluído.
Revisão da literatura atualizada até:  fevereiro de 2024.
Última atualização deste tópico:  09 de janeiro de 2024.
(Consulte "Depressão unipolar em adultos: características clínicas" .)●
(Veja "Depressão unipolar em adultos: curso da doença" .)●
(Veja "Depressão unipolar em adultos: avaliação e diagnóstico" .)●
(Consulte "Depressão unipolar maior em adultos: escolha do tratamento inicial" .)●
(Consulte "Depressão unipolar em adultos: escolha do tratamento para depressão
resistente" .)
●
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PREVALÊNCIA
A depressão unipolar é altamente prevalente em adultos em todo o mundo.
Prevalence in general medical disorders — Depressive syndromes are highly prevalent
across the world in outpatients with general medical disorders and appear to be more
common in these outpatients than the general population (see 'Prevalence in general
population' below). A meta-analysis identified 83 cross-sectional studies from five continents
that included outpatients with general medical disorders (total n >41,000); studies of patients
whose depression predated their general medical disorders were excluded [4]. The pooled
point prevalence of depression was 27 percent. However, heterogeneity across studies was
very large, and the prevalence in different specialties varied from approximately 15 to 50
percent. A subgroup of eight studies compared outpatients (n >3000) with controls who did
not have general medical disorders (n >3000), and found that the pooled point prevalence
was three times greater in outpatients (18 versus 6 percent).
Prevalence in general population
Worldwide — Depression is highly prevalent in the general population of adults throughout
the world. Nationally or regionally representative surveys in 21 countries estimate that the 12-
month prevalence of unipolar major depression across all countries is 5 percent [5]. In
addition, the lifetime prevalence of unipolar major depression plus persistent depressive
disorder (dysthymia), according to surveys in 14 countries, is approximately 12 percent [6].
Among the 14 countries [6]:
Estado de humor, indicado por sentimentos de tristeza, desespero, ansiedade, vazio,
desânimo ou desesperança; não ter sentimentos; ou parecendo choroso. O humor
deprimido (disfórico) pode ser normal ou um sintoma de uma síndrome psicopatológica
ou de um distúrbio médico geral.
●
Síndrome, que é uma constelação de sintomas e sinais que podem incluir humor
deprimido. As síndromes depressivas normalmente encontradas incluem depressão
maior, depressão menor ou distimia (transtorno depressivo persistente).
●
Transtorno mental que identifica uma condição clínica distinta. Por exemplo, a síndrome
de depressão maior pode ocorrer em vários transtornos, como depressão maior
unipolar (também chamada de “transtorno depressivo maior”), transtorno bipolar,
esquizofrenia, transtorno depressivo induzido por substância/medicamento e
transtorno depressivo devido a outro ( geral) condição médica.
●
The prevalence of unipolar major depression plus persistent depressive disorder in
developed countries (United States and Europe) is approximately 18 percent.
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This twofold difference between developed and resource-limited countries may reflect true
variation in the determinants of depression due to cultural or genetic factors, sample
selection biases, and problems with the cross-cultural portability of diagnostic criteria [7,8].
United States — Depression is highly prevalent in the general population of the United
States. A nationally representative survey of adults in the United States found that the 12-
month prevalence of unipolar major depression was 10 percent, and the lifetime prevalence
was 21 percent [9].
The prevalence of persistent depressive disorder (dysthymia) appears to be less than that of
unipolar major depression. As an example, a nationally representative survey found that the
lifetime prevalence of persistent depressive disorder was 3 percent [10].
Other countries — Depressive syndromes are highly prevalent in the general population of
many countries beyond the United States. Nationally or regionally representative community
surveys in different countries found that the 12-month prevalence of unipolar major
depression was as follows [5]:
In resource-limited countries (eg, People’s Republic of China, Mexico, and Brazil), the
estimated lifetime prevalence is 9 percent.
●
Argentina – 4 percent●
Belgium – 5 percent●
Brazil – 10 percent●
Bulgaria – 3 percent●
China (People’s Republic) – 2 percent●
Colombia – 5 percent●
France – 6 percent●
Germany – 3 percent●
Iraq – 4 percent●
Israel – 6 percent●
Italy – 3 percent●
Japan – 2 percent●
Lebanon – 5 percent●
Mexico – 4 percent●
Netherlands – 5 percent●
Nigeria – 1 percent●
Peru – 3 percent●
Portugal – 7 percent●
Romania – 2 percent●
Spain – 4 percent●
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AGE OF ONSET
Multiple studies consistently indicate that in the general population of the United States, the
average age of onset for unipolar major depression and for persistent depressive disorder
(dysthymia) is approximately 30 years [10,11]. As an example, a nationally representative
survey of adults found that onset of the first lifetime episode of major depression occurs at
age 29 years [9].
DEMOGRAPHIC RISK FACTORS
Several sociodemographic factors are associated with an increased risk for unipolar
depression.
Age — Within the general population of the United States, major depression is more common
in younger adults than older adults. A nationally representative survey found that the 12-
month prevalence of unipolar major depression was greater in younger age groups than
adults aged 65 years or more (11 to 13 versus 5 percent) [9]. In addition, the lifetime
prevalence was greater in younger age groups (20 to 23 versus 14 percent). Similarly, a
subsequent survey found that clinically significant depressive symptoms were more common
among younger adults [12].
The prevalence of depression in older adults declines as they age. A community survey of
adults aged 55 years and older in the United States found that the 12-month prevalence of
major depression decreased significantly with increasing age [13].
However, certain groups of older adults have higher rates of depression compared with older
adults in general. The prevalence in older primary care patients is comparable to that of
younger patients [14,15]. Depression is even more common in older adults with a greater
burden of medical illness, including residents of assisted living or skilled nursing facilities,
recipients of home health care, and patients suffering from a wide range of acute and chronic
medical conditions [16-19].
Income — In the general population of the United States, the prevalence of major depression
is greater among individuals with less income. A 2013 nationally representative survey in the
United States found that the 12-month prevalence of unipolar major depression in lower
household income categories is greater compared with the highest family income category
($70,000 or more; 10 to 14 versus 8 percent) [9]. However, the differences in the lifetime
prevalence of major depression between lower categories and the highest category are less
pronounced (20 to 23 and 20 percent).
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Marital status — A nationally representative survey in the United States found that the
prevalence of unipolar major depression is highest in adults who are divorced, separated, or
widowed [9]:
Race/ethnicity — A nationally representative survey in the United States found that the
prevalence of unipolar major depression among different racial groups is highest in Native
Americans and lowest in Asians/Pacific Islanders [9]:
Sex — Within the general population of the United States, as well as other countries, the
prevalence of depressive syndromes is approximately two times greater in females than
males [20,21]:
Twelve-month prevalence●
Married/cohabitating – 8 percent•
Never married – 13 percent•
Divorced, separated, or widowed – 14 percent•
Lifetime prevalence●
Married/cohabitating – 19 percent•
Never married – 21 percent•
Divorced, separated, or widowed – 26 percent•
Twelve-month prevalence●
Asian/Pacific Islander – 7 percent•
Black – 9 percent•
Hispanic – 10 percent•
Native American – 16 percent•
White – 11 percent•
Lifetime prevalence●
Asian/Pacific Islander – 12 percent•
Black – 15 percent•
Hispanic – 16 percent•
Native American – 28 percent•
White – 23 percent•
A nationally representative survey in the United States found that the 12-month
prevalence of unipolar major depression in females and males is 13 and 7 percent [9]. In
addition, the lifetime prevalence in females and males is 26 and 15 percent.
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The prevalence rates for females and males may differ because the etiology of depression in
each sex is different [23].
SUMMARY AND RECOMMENDATIONS
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Surveys of community-dwelling adults in 15 countries (including the United States)
found that the lifetime prevalence of major depression and persistent depressive
disorder (dysthymia) were each 1.9 times higher in females compared with men [22].
●
Population prevalence – The estimated 12-month prevalence of unipolar major
depression in the worldwide general population is 5 percent. In addition, the lifetime
prevalence of unipolar major depression plus persistent depressive disorder (dysthymia)
is approximately 12 percent. The estimated 12-month prevalence of unipolar major
depression in specific countries apart from the United States ranges from 1 to 10
percent. (See 'Worldwide' above and 'Other countries' above.)
●
Among the general population of adults in the United States, the estimated 12-month
prevalence of unipolar major depression is 10 percent, and the lifetime prevalence is 21
percent. (See 'United States' above.)
Prevalence in outpatient clinical settings – Across the world, the point prevalence of
depression in outpatients with general medical disorders is roughly 25 percent and
depressive syndromes appear to be more common in outpatient clinical settings than
the community (general population). (See 'Prevalence in general medical disorders'
above.)
●
Age of onset – The average age of onset for unipolar major depression and for
persistent depressive disorder (dysthymia) in the general population of the United States
is approximately 30 years. (See 'Age of onset' above.)
●
Demographic risk factors – Within the general population of the United States, major
depression is more common in younger adults, individuals with less income, and is
highest in adults who are divorced, separated, or widowed. In the United States, the
prevalence of unipolar major depression among different racial groups is highest in
Native Americans and lowest in Asians/Pacific Islanders.
●
Worldwide, the prevalence of depressive syndromes in the general population is
approximately two times greater in females than males. (See 'Age' above and 'Income'
above and 'Marital status' above and 'Race/ethnicity' above and 'Sex' above.)
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