Prevalence and Incidence Studies of Mood Disorders: A Systematic Review of the Literature

This is the second in a series of papers that present systematic reviews of the prevalence and incidence of psychiatric disorders drawn from studies published in English literature in the years 1980 to 2000. The series discusses the implications of these epidemiologic findings to mental health policy and practice. Objective: To present the results of a systematic review of literature published between January 1, 1980, and December 31, 2000, that reports findings on the prevalence and incidence of mood disorders in both general population and primary care settings. Method: We conducted a literature search of epidemiologic studies of mood disorders, using Medline and HealthSTAR databases and canvassing English-language publications. Eligible publications were restricted to studies that examined subjects aged at least 15 years and over. We used a set of predetermined inclusion and exclusion criteria to identify relevant studies. We extracted and analyzed prevalence and incidence data for heterogeneity. Results: Of general population studies, a total of 18 prevalence and 5 incidence studies met eligibility criteria. We found heterogeneity across 1-year and lifetime prevalence of major depressive disorder (MDD), dysthymic disorder, and bipolar I disorder. The corresponding pooled rates for 1-year prevalence were 4.1 per 100, 2.0 per 100, and 0.72 per 100, respectively. For lifetime prevalence, the corresponding pooled rates were 6.7 per 100, 3.6 per 100, and 0.8 per 100, respectively. Significant variation was observed among 1-year incidence rates of MDD, with a corresponding pooled rate of 2.9 per 100. Conclusions: The prevalence of mood disorders reported in high-quality studies is generally lower than rates commonly reported in the general psychiatric literature. When controlled for common methodological confounds, variation in prevalence rates persists across studies and deserves continued study. Methodological variation among studies that have examined the prevalence of depression in primary health care services is so large that comparative analyses cannot be achieved.