The Epidemiology of Depression: A Family Affair
Experts are beginning to better understand and mitigate the economic and social consequences of disabling psychiatric illnesses like depression.
Published March 1, 2002
By Henry Moss, PhD
Academy Contributor

Health insurance reimbursement for mental disorders has still not achieved parity with traditional illness and the topic continues to be hotly debated in the U.S. Congress. The statistics seem clear, however, as studies document the enormous economic and social consequences of disabling psychiatric illnesses. Broken marriages, lost jobs and productivity, and the impact on children make mental illness one of the major sources of disability loss in the United States and the world.
Columbia University psychiatric epidemiologist Dr. Myrna Weissman made a powerful case for parity when she presented the cumulative results of major studies led by her and colleagues to an Academy audience in January. The talk was part of an ongoing program by the Academy on “Mind, Brain and Society.” Dr. Weissman, who is also associated with the New York State Psychiatric Institute, dealt specifically with unipolar, major depression, perhaps the most widespread and significant of these disorders, and one that now appears to amplify its effect by impacting families – young mothers and children in particular.
Perhaps the most significant finding is that, contrary to popular belief, depression is not a middle-aged, menopausal phenomenon. Recent studies show a substantial rise in the onset of depression at puberty and a peak that occurs between age 25 and 35, for both men and women, though incidence is substantially higher in women. Onset actually declines beyond age 35, implying that, as Weissman put it, “if you can make it to 50 you can pretty much look past depression and ahead to your dementias.” They also show that depression is most damaging in the sensitive child-bearing years of young women.
Depression and Other Health Complications

Science is only now coming to grips with the significance of this data. Given depression’s early onset, we now recognize that people live with the debilitating disorder far longer than with heart disease, for example, or most diabetes. Indeed, the World Health Organization ranks unipolar depression number one in years of disability.
Weissman also noted that when women of child-bearing age are affected the impact is increased substantially. Children of depressed parents have a two to threefold increased risk for the illness, according to studies conducted by Weissman’s group. They also are more likely to experience earlier onset, around age 15, and to account for a major share of the small but significant number of cases among pre-pubescent children. They may then suffer the effects for a lifetime.
We’ve known that depression amplifies a number of general health problems, Weissman said, but it’s now becoming clear that the illness has a more devastating social impact than was previously thought. We can only imagine how it affects developing countries ravaged by AIDS and/or war. And it gets worse. The studies show that the effect remains robust across multiple generations; a grandparent with major depression may be an even stronger predictor for familial depression than is a parent.
The good news, according to Weissman, is that we’ve learned a lot about treating depression and other psychiatric conditions, with drugs and psychotherapy, and that outreach can overcome reluctance to seek treatment. But we need resources to conduct effective outreach and deliver treatment, and health insurance parity would certainly be a good start.
Myrna Weissman is a member of the National Academy of Science’s Institute of Medicine, and a Fellow of The New York Academy of Sciences.
Also read: Psychedelics to Treat Depression and Psychiatric Disorders