Epidemiology of major depressive episode in a southern European country: Results from the ESEMeD-Spain project

Background: Information of the epidemiology of Major Depressive Episode (MDE) in Spain,one of the biggest southern European countries, is scarce and heterogeneous. The objective of this study was to assess the epidemiology of the disorder in the Spanish sample of the ESEMeD project. Methods: The ESEMED-Spain project is a cross-sectional, general population, household survey conducted with a representative sample of Spanish non-institutionalized adult population. The survey instrument was the CIDI 3.0, a structured diagnostic interview to assess disorders and treatment. Results: Lifetime prevalence was 10.6% while 12-month prevalence was 4.0%. A monotonic increase in lifetime overall prevalence was found from the youngest to the 50-64 cohort, declining then in the oldest group. Median age of onset was 30.0. Being a woman (OR = 2.7), previously married (OR = 1.8), unemployed or disabled to work (OR = 2.9) was associated to higher risk of 12-month-MDE. The highest comorbid associations were with dysthymia (OR = 73.1) and panic disorder (OR = 41.8). Limitations: 1. Psychiatric diagnoses were made by trained lay interviewers and this could have an imperfect sensitivity/specificity: 2. Individuals with mental illness could have more frequently rejected to participate in the survey; 3. Age-related recall bias could have affected the accuracy of age of onset estimates. Conclusions: The study shows that prevalence MDE in Spain is lower than in other Western countries. Important findings are the early age of onset, the high proportion of chronicity, and the high female/male ratio. Taken together, results offer a complex picture of the epidemiology of MDE in Spain, when compared to other countries in Europe. The role of cultural factors is discussed. (C) 2009 Elsevier B.V. All rights reserved.