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Double depression: its morbidity and management in a community setting

Published online by Cambridge University Press:  24 June 2014

Robert D. Goldney*
Affiliation:
University of Adelaide, Adelaide, South Australia, Australia
Marcus A. Bain
Affiliation:
Ramsay Health Care (SA), Adelaide, South Australia, Australia
*
Professor Robert D. Goldney, The Adelaide Clinic, 33 Park Terrace, Gilberton, South Australia 5081, Australia. Tel: 08 8269 8153; Fax: 08 8269 6851; E-mail: [email protected]

Abstract

Background:

Double depression, the combination of major depression and dysthymia, is associated with poor health-related quality of life (HRQoL) and increased health service utilization.

Objective:

To determine the prevalence of double depression, its associated morbidity and use of health services and antidepressants.

Methods:

A random and representative sample of the South Australian general population was interviewed. The mood module of the Primary Care Evaluation of Mental Disorders (PRIME-MD), the Short-Form Health Status Questionnaire (SF-36) and Assessment of Quality of Life (AQoL) instruments were administered, and data relating to health service utilization, antidepressant use and role functioning were collected.

Results:

Double depression was present in 3.3% of the population. The use of health services was significantly higher in this group than those with no depression, or dysthymia or major depression alone. Only 15.2% had attended a community health service, 18.2% had seen a psychiatrist, 10.1% a psychologist, 16.2% a social worker and 9.1% any other counsellor in the last month. While 41.4% were currently taking an antidepressant, the average doses of the two most commonly prescribed antidepressants were below the maximum recommended doses, and the use of antidepressant augmentation strategies was also minimal.

Conclusions:

While double depression is associated with increased morbidity and use of health services, the optimum use of both pharmacological and nonpharmacological treatments is clearly lacking in this community sample.

Type
Research Article
Copyright
Copyright © 2006 Blackwell Munksgaard

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References

Keller, MB, Hirschfeld, RM, Hanks, D. Double depression: a distinctive subtype of unipolar depression. J Affect Disord 1997;45:6573. CrossRefGoogle ScholarPubMed
Murray, C, Lopez, A. The global burden of disease. Geneva: World Health Organization and Harvard University Press, 1996. Google ScholarPubMed
Bebbington, P, Hurry, J, Tennant, C, Sturt, E, Wing, JK. Epidemiology of mental disorders in Camberwell. Psychol Med 1981;11:561579. CrossRefGoogle ScholarPubMed
Oakley-Browne, MA, Joyce, PR, Wells, JE, Bushnell, JA, Hornblow, AR. Christchurch Psychiatric Epidemiology Study, Part II: Six month and other period prevalences of specific psychiatric disorders. Aust N Z J Psychiatry 1989;23:327340. CrossRefGoogle ScholarPubMed
Regier, DA, Farmer, ME, Rae, DSet al. One-month prevalence of mental disorders in the United States and sociodemographic characteristics: the Epidemiologic Catchment Area study. Acta Psychiatr Scand 1993;88:3547. CrossRefGoogle ScholarPubMed
Kessler, RC, McGonagle, KA, Zhao, Set al. Lifetime and 12-month prevalence of DSM-III-R psychiatric disorders in the United States. Results from the National Comorbidity Survey. Arch Gen Psychiatry 1994;51:819. CrossRefGoogle ScholarPubMed
Henderson, S, Andrews, G, Hall, W. Australia’s mental health: an overview of the general population survey. Aust N Z J Psychiatry 2000;34:197205. CrossRefGoogle ScholarPubMed
Andrews, G, Slade, T, Issakidis, C. Deconstructing current comorbidity: data from the Australian National Survey of Mental Health and Well-Being. Br J Psychiatry 2002;181:306314. CrossRefGoogle ScholarPubMed
Weissman, MM, Leaf, PJ, Tischler, GLet al. Affective disorders in five United States communities. Psychol Med 1988;18:141153. CrossRefGoogle ScholarPubMed
Frances, A. Problems in defining clinical significance in epidemiological studies. Arch Gen Psychiatry 1998;55:119. CrossRefGoogle ScholarPubMed
Spitzer, RL. Diagnosis and need for treatment are not the same. Arch Gen Psychiatry 1998;55:120. CrossRefGoogle Scholar
Parker, G. Dealing with depression. Sydney, Australia: Allen and Unwin, 2004. Google Scholar
Goldney, RD, Fisher, LJ. Double depression in an Australian population. Soc Psychiatry Psychiatr Epidemiol 2004;39:921926. CrossRefGoogle Scholar
Wilson, D, Wakefield, M, Taylor, A. The South Australian Health Omnibus Survey. Health Promot J Austr 1992;2:4749. Google Scholar
Australian Bureau of Statistics. Population by age and sex, Australian states and territories. Canberra, Australia: Australian Bureau of Statistics, 2001 (ABS Cat. No. 3201.0). Google ScholarPubMed
Boyer, P, Bisserbe, J-C, Weiller, E. How efficient is a screener? A comparison of the PRIME-MD patient questionnaire with the SDD-PC screen. Int J Methods Psychiatr Res 1997;7:2732. CrossRefGoogle Scholar
Spitzer, RL, Williams, JB, Kroenke, Ket al. Utility of a new procedure for diagnosing mental disorders in primary care. The PRIME-MD 1000 study. JAMA 1994;272:17491756. CrossRefGoogle ScholarPubMed
Australian Bureau of Statistics. Census of population and housing: socio-economic indexes for areas (SEIFA), Australia. Canberra, Australia: Australian Bureau of Statistics, 2001 (ABS Cat. No. 2033.0.55.001). Google Scholar
Ware, J, Kosinski, M, Keller, S. SF-36 physical and mental health summary scales: a user’s manual. Boston: Health Institute, New England Medical Center, 1994. Google Scholar
McCallum, J. The SF-36 in an Australian sample: validating a new, generic health status measure. Aust J Public Health 1995;19:160166. CrossRefGoogle Scholar
Australian Bureau of Statistics. National health survey: SF-36 population norms. Canberra, Australia: Australian Bureau of Statistics, 1995 (ABS Cat. No. 4399.0). Google ScholarPubMed
Behavioural Epidemiology Unit. South Australian Population Norms for the SF-36. Adelaide, Australia: South Australian Health Commission, 1995. Google ScholarPubMed
Hawthorne, G, Richardson, J, Osborne, R, McNeil, H. The assessment of quality of life (AQoL) instrument: construction, initial validation and utility scaling. Working Paper 76. Melbourne, Australia: Monash University, 1997. Google Scholar
Hawthorne, G, Richardson, J, Osborne, R. The Assessment of Quality of Life (AQoL) instrument: a psychometric measure of health-related quality of life. Qual Life Res 1999;8:209224. CrossRefGoogle ScholarPubMed
Jonas, BS, Brody, D, Roper, M, Narrow, WE. Prevalence of mood disorders in a national sample of young American adults. Soc Psychiatry Psychiatr Epidemiol 2003;38:618624. CrossRefGoogle Scholar
Wells, KB, Burnam, MA, Rogers, W, Hays, R, Camp, P. The course of depression in adult outpatients. Results from the Medical Outcomes Study. Arch Gen Psychiatry 1992;49:788794. CrossRefGoogle ScholarPubMed
Australian Medicines Handbook. 2006. Adelaide, Australia: Australian Medicines Handbook, 2006. Google Scholar
Valenstein, M, McCarthy, JF, Austin KL et al. What happened to lithium? Antidepressant augmentation in clinical settings. Am J Psychiatry 2006;163:12191225. CrossRefGoogle ScholarPubMed
Duarte, A, Mikkelsen, H, Delini-Stula, A. Moclobemide versus fluoxetine for double depression: a randomized double-blind study. J Psychiatr Res 1996;30:453458. CrossRefGoogle ScholarPubMed
Amore, M, Jori, MC. Faster response on amisulpride 50 mg versus sertraline 50-100 mg in patients with dysthymia or double depression: a randomized, double-blind, parallel group study. Int Clin Psychopharmacol 2001;16:317324. CrossRefGoogle ScholarPubMed
Ramasubbu, R. Treatment of resistant depression by adding noradrenergic agents to lithium augmentation of SSRIs. Ann Pharmacother 2002;36:634640. CrossRefGoogle ScholarPubMed
Lecrubier, Y, Boyer, P, Turjanski, S, Rein, W. Amisulpride versus imipramine and placebo in dysthymia and major depression. Amisulpride Study Group. J Affect Disord 1997;43:95103. CrossRefGoogle ScholarPubMed
Marin, DB, Kocsis, JH, Frances, AJ, Parides, M. Desipramine for the treatment of “pure” dysthymia versus “double” depression. Am J Psychiatry 1994;151:10791080. Google ScholarPubMed
Miller, IW, Norman, WH, Keitner, GI. Combined treatment for patients with double depression. Psychother Psychosom 1999;68:180185. CrossRefGoogle ScholarPubMed
Fava, M, Rush, AJ. Current status of augmentation and combination treatments for major depressive disorder: a literature review and a proposal for a novel approach to improve practice. Psychother Psychosom 2006;75:139153. CrossRefGoogle Scholar
Souery, D, Papakostas, GI, Trivedi, MH. Treatment-resistant depression. J Clin Psychiatry 2006;67(Suppl. 6):1622. Google ScholarPubMed
Hawthorne, G, Cheok, F, Goldney, R, Fisher, L. The excess cost of depression in South Australia: a population-based study. Aust N Z J Psychiatry 2003;37:362373. CrossRefGoogle ScholarPubMed
Goldney, R, Fisher, L, Dal Grande, E, Taylor, A, Hawthorne, G. Have education and publicity about depression made a difference? A comparison of prevalence, service use and excess costs in South Australia: 1998 and 2004. Aust N Z J Psychiatry 2006 (in press).Google ScholarPubMed
Andrews, G. It would be cost-effective to treat more people with mental disorders. Aust N Z J Psychiatry 2006;40:613615. CrossRefGoogle ScholarPubMed