The prevalence of depressive disorders in the United Kingdom

Background: The prevalence of major psychiatric disorders in the general po pulation is difficult to pinpoint owing to widely divergent estimates yield ed by studies employing different criteria, methods, and instruments. Depre ssive disorders, which represent a sizable mental health care expense for t he public purse, are no exception to the rule. Methods. The prevalence of depressive disorders was assessed in a represent ative sample (n = 4972) of the U.K. general population in 1994. Interviews were performed over the telephone by lay interviewers using an expert syste m that tailored the questionnaire to each individual based on prior respons es. Diagnoses and symptoms lists were based on the DSM-IV. Results: Five percent (95% confidence interval = 4.4-5.6%) of the sample wa s diagnosed by the system with a depressive disorder at the time of the int erview, with the rate slightly higher for women (5.9%) than men (4.2%). Une mployed, separated, divorced, and widowed individuals were found to be at h igher risk for depression. Depressive subjects were seen almost exclusively by general practitioners (only 3.4% by psychiatrists). Only 12.5% of them consulted their physician seeking mental health treatment, and 15.9% report ed being hospitalized in the past 12 months. Conclusions: The study indicates that mental health problems in the communi ty are seriously underdetected by general practitioners, and that these pro fessionals are highly reluctant to refer patients with depressive disorders to the appropriate specialist. Biol Psychiatry 1999;45:300-307 (C) 1999 So ciety of Biological Psychiatry.