Comparison of treated and untreated major depressive disorder in a nationwide sample of Korean adults

Individuals with MDD manifest various symptoms ranging from depressive mood to suicide idea [1]. Some of symptoms can be more distressing and make them seek treatment, while other symptoms can be ignored because they are less distressing, thought to be self-limited, or thought to be untreatable. In addition, MDD is often comorbid with other psychiatric disorders [2], which could aggravate depression and vice versa and affect mental health service utilization of depressed patients. The objective of this study is to examine the correlates of treatment-seeking in respondents with MDD, including psychopathology and comorbid psychiatric conditions in addition to the relatively well-known socio-demographic and clinical characteristics in a nationwide community sample in Korea. Among the total of 6,510 subjects aged 18−64 years participated in the Korean Epidemiologic Catchment Area study (KECA-R), 362 subjects with lifetime diagnosis of MDD were selected for the analysis in the present study. Diagnostic assessments were based on the Korean version of Composite International Diagnostic Interview 2.1 [3] administered by lay interviewers. Among 362 respondents with lifetime diagnosis of MDD, 32.3% (171/362) have ever treated for mental health problems. Among 161 subjects diagnosed as having 12-months MDD, 17.4% (28/161) have treated for mental health problems in the preceding 12 months. Treated individuals with MDD were more likely to be older and have a medical illness than untreated participants. Sex, area of residence, marital status, educational level, and type of occupation were not associated with treatment. Compared to the untreated cases, treated individuals with MDD were more likely to have chronic episode (OR 1.86, 95% CIs 1.13– 3.06), more depression symptoms (OR 1.69, 95% CIs 1.05–2.71), insomnia (OR 2.43, 95% CIs 1.22–4.85), and suicidal ideation (OR 2.03, 95% CIs 1.21–3.38), and less likely to have guilty feeling (OR 0.55, 95% CIs 0.32–0.97). In addition, treated individuals with MDD were more likely to have comorbid anxiety disorder, especially obsessive-compulsive disorder, post-traumatic stress disorder, and generalized anxiety disorder than untreated participants. No comorbid psychiatric disorder was significantly associated with underuse of psychiatric treatment. In case of untreated individuals with MDD, the most common reason for not seeking treatment was that they wanted to handle the problem on their own (71.7%). The second most common reason was that they did not think they had a mental illness (65.8%). The following common reasons were that they thought that the problem would get better by itself (54.0%), the problem did get better by itself (47.1%), and the problem did not bother respondent very much (35.8%). Treatment-seeking of persons with MDD is affected by manifesting psychopathology and comorbid medical and psychiatric disorder as well as socio-demographic factors and characteristic of depressive episode. While it is reassuring that chronic and severe patients who should receive a treatment report higher rates of treatment-seeking, persons with MDD still underuse the mental health service, and effort should be directed to reduce stigma associated with mental illness and to get depressed patients involved in treatment earlier.Kessler RC, 2003, JAMA-J AM MED ASSOC, V289, P3095*AM PSYCH ASS, 2000, DIAGN STAT MANN MENTCHO MJ, 1999, ANN M KOR NEUR ASS S