In major epidemiological studies, the mean time lag between onset and clinical treatment for major depressive disorder is determined to be around:
C. According to NESARC (National Epidemiological Survey of Alcoholism and Related Conditions) the mean age of onset of depression is 30 years, the mean number of episodes in patients with lifetime major depressive disorder is fi ve, and the mean age of treatment onset for depression is 33.5 years. This lag of around 3 years is noted in other community samples that studied treatment seeking for depression. It is currently unclear if untreated depression, as noted in population surveys, affects clinical outcome in long-term follow-up.
Considering the epidemiology of major depressive disorder, which of the following is incorrect with respect to seeking treatment?
D. Nearly 40% of depressive episodes do not come to clinical attention even in developed nations (NESARC study). The World Mental Health Survey initiative organized by the WHO revealed that older generational cohorts of depressed people, men, those with earlier age of depression onset, and those who are living in developing compared to developed countries are poor seekers of treatment for depression. The situation is even worse for anxiety and substanceuse disorders. An encouraging finding was that those with severe illness sought treatment more often than those with milder illnesses.
Major depressive disorder often coexists with personality disorders.
Which of the following groups of personality disorders is most commonly associated with depression?
C. The most common comorbidities with depression in epidemiological surveys are alcohol use (>40%) and anxiety (>40%). It is noted that cluster C personality disorders, with the exception of obsessive compulsive personality disorder, show strong associations with lifetime major depression in large-scale community surveys. In Question 13, choice A refers to cluster A personality, choice B to cluster B, and choice C to two of the three cluster C personality disorders. Choice D includes disorders described in DSM IV but not clustered in any of the three groups.
What is the proportion of patients with major depression and lifetime comorbidity of personality disorders in community samples?
E. It is important to note that the prevalence of personality disorders in those who attend psychiatric services or primary-care services are higher than community prevalence rates. The rate of personality disorders is recorded to be very high in institutions such as prisons and psychiatric hospitals providing long-term services. The prevalence of any personality disorder in community samples is estimated to be around 13% in the UK. The comorbid association of diagnosable personality disorder and depression was explored in NESARC study, which revealed 30% of depressed patients in the community have a comorbid personality disorder.
To estimate the number of homeless mentally ill patients, an initial survey was carried out in a defined area of central London and identified patients were registered. Six months later, another random sampling was carried out and using the identified proportion of previously registered homeless mentally ill, reliable population values were deducted.
This method of epidemiological survey is best described as:
A. This is called capture–recapture technique. It is useful in estimating the size of a population that cannot be directly estimated as only a fraction is observable when using sampling techniques. Initially, a random sample from the population of interest is drawn (e.g. mentally ill homeless population). After registering these patients they are allowed to mix with the population (using a registration tag, they can be identified again). When complete mixture with the total population has occurred, a second random sample is drawn. From the prevalence of the registered patients in the second sample, the size of the total population may be calculated. This technique is being used in animal research to provide estimates of census of animals.
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