Exogenous corticosteroids and major depression in the general population

Objective: An existing literature suggests that corticosteroid exposures are associated with an elevated level of depressive symptoms in various clinical populations. The objective of this study was to evaluate this association in a general population sample. Methods: Data from a large-scale Canadian health survey were used in this analysis. The survey sample included 73,402 subjects over the age of 12 from the general Canadian population. The survey interview included a short-form version of the Composite international Diagnostic Interview (CIDI) section evaluating major depressive episodes. All estimates were weighted to account for unequal selection probabilities, and variance estimates were calculated using methods accounting for the survey design. Results: A statistically significant elevation in major depression prevalence was observed in corticosteroid-treated subjects. The estimated 12-month period prevalence of major depression was approximately three times as high in corticosteroid treated vs. non-treated subjects irrespective of age, gender and perceived health. Conclusions: In the general population, persons taking corticosteroids have a higher frequency of major depression than non-exposed subjects. Because this was an analysis of cross-sectional survey data, causal inference is not possible. However, the existence of an epidemiological association, in conjunction with information from the broader literature, suggests that corticosteroid exposure may be a determinant of depressive disorders in the general population. (C) 2001 Elsevier Science Inc. All rights reserved.