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Dysthymia more impairing than depression.

BOCA RATON, FLA. -- Dysthymic disorder, or chronic low-grade depression, confers a high degree of impairment and represents a significant public health burden, according to a secondary analysis of a large epidemiologic study.

"The point is, dysthymia is a very dysfunctional illness, even relative to acute major depression," Dr. Jonathan W. Stewart said.

The investigators found greater impairments in some psychosocial-functioning indicators for the previous month and the previous year among people with dysthymic disorder, compared either with others who had acute major depressive disorder or with the general population.

The dysthymic patients had greater use of supplemental Social Security disability income and higher receipt of Medicaid insurance, and were less likely to be working full time compared with the other groups, according to results that were published online (J. Affect. Disord. 2010 May 1 [Epub ahead of print]).

"This is not the way a lot of people view dysthymia. Dysthymia is what ruins peoples' lives," said Dr. Stewart of Columbia University and the New York State Psychiatric Institute, both in New York City.

In the previous year, Social Security disability was reported by 14% of the dysthymic group, 5% of the major depression group, and 3% of the general population group. Receipt of Medicaid insurance was reported by 20% of the dysthymic group, 13% of the major depression group, and 6% of the general population participants.

These results come from their secondary analysis of NESARC (National Epidemiologic Survey of Alcoholism and Related Conditions). NESARC features a nationally representative sample of 43,093 noninstitutionalized US. adults. Dr. Stewart and his associates identified 328 respondents with dysthymic disorder (without current major depression); 712 with acute major depressive disorder (symptoms for 24 months or fewer); and 42,052 other participants who accounted for the general population group.

Full-time employment was reported by 36% of the dysthymic patients, 44% of the major depression patients, and 52% of the general population.

The investigators also assessed previous month functioning using the 12-item Short Form Health Survey scores. Participants were asked: Have you accomplished less because of emotional problems? In all, 13% of the dysthymic group, 8% of the major depression group, and 3% of the general population group said "all of the time."

Diagnoses were based on the National Institute on Alcohol Abuse and Alcoholism's AUDADIS (Alcohol Use Disorder and Associated Disabilities Interview Schedule)-DSM-IV version. This community-based study supports findings from clinical studies that chronic depression can impart significant psychosocial impairment, Dr. Stewart said.

Diagnosis of dysthymic disorder is not always easy. "It's a big problem. When [patients] come to your office, they don't have a lot of symptoms," Dr. Stewart said. Even clinicians who go through a "laundry list for major depression" might miss it, he added, and as a result, some patients might be misdiagnosed as not depressed.

Dr. Stewart's recommendation was simple: "I go for the mood myself. If you come into my office and say you're depressed, by God, you are depressed."


Major Finding: Compared with people who have acute major depression, people with dysthymic disorder were more likely to receive Social Security disability (5% vs. 14%) and Medicaid insurance (13% vs. 20%), and were less likely to report full-time employment (44% vs. 36%).

Data Source: Secondary analysis of 43,093 community-based adults surveyed for NESARC.

Disclosures: Dr. Stewart said that he had no relevant disclosures.


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Title Annotation:PSYCHIATRY
Author:McNAMARA, Damian
Publication:Internal Medicine News
Geographic Code:1USA
Date:Sep 15, 2010
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