Epidemiology

Key Points

• Major depression and anxiety disorders are the two most common psychiatric illnesses in the United States.

• The economic burden of anxiety and depressive disorders is substantial in terms of workdays lost, disability, health care expenditures, and mortality.

• Anxiety and depression are chronic illnesses that typically run a waxing/waning course.

• Prevalence rates for anxiety disorders appear to decline with advancing age, except for GAD, which may increase in geriatric populations.

• Depression is often a highly recurrent illness; each episode of depression increases the likelihood of future episodes.

Prevalence estimates of mental disorders in the United States continue to find that anxiety and mood disorders are the two most common mental disorders in the general population. Lifetime prevalence for anxiety disorders is estimated at 16.6% to 28.8% (Conway et al., 2006; Kessler et al., 2005a) and for major depression is 14.9% to 16.2% (Kessler et al., 2003). Recent 12-month prevalence rates show a similar stratification, with anxiety disorders most common (18.1%), followed by mood disorders (9.5%). Lifetime prevalence rates of panic disorder and GAD are 4.7% and 5.7%, respectively (Kessler et al., 2005a). Anxiety disorders make up approximately 2% of all office visits to physicians in the United States, but almost 50% occur in primary care settings. In comparison, approximately 40% of patients presenting with anxiety disorders are seen by psychiatrists (Harman et al., 2002).

Major depression remains a common disorder and is associated with substantial symptom severity and role impairment (Kessler et al., 2003). One-year prevalence rates for major depression are approximately 6% in the general population, followed by dysthymia (1.8%) and bipolar disorders (1%-2%). Rates in primary care settings remain substantially higher, with prevalence of 10% or greater (Spitzer et al., 1994), although many of these patients suffer from depressions that are unrecognized by their primary care physician (Schultheis et al., 1999).

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