The higher rate of depression in women is not explained by gender differences in negative life events, social support or vulnerability.

Depressive disorder is a highly prevalent condition in Europe. The major finding is the wide difference in the prevalence of depressive disorders found across the study sites.

Schizophrenia and depression are associated with an elevated risk of natural and unnatural deaths.

There is an urgent need to ascertain whether the high mortality in schizophrenia is attributable to the disorder itself or the antipsychotic medication.

Objectives To determine the acceptability of two psychological interventions for depressed adults in the community and their effect on caseness, symptoms, and subjective function. Design A pragmatic multicentre randomised controlled trial, stratified by centre. Setting Nine urban and rural communities in Finland, Republic of Ireland, Norway, Spain, and the United Kingdom. Participants 452 participants aged 18 to 65, identified through a community survey with depressive or adjustment disorders according to the international classification of diseases, 10th revision or Diagnostic and Statistical Manual of Mental Disorders, fourth edition. Interventions Six individual sessions of problem solving treatment (n = 128), eight group sessions of the course on prevention of depression (n = 108), and controls (n = 189). Main outcome measures Completion rates for each intervention, diagnosis of depression, and depressive symptoms and subjective function. Results 63% of participants assigned to problem solving and 44% assigned to prevention of depression completed their intervention. The proportion of problem solving participants depressed at six months was 17% less than that for controls, giving a number needed to treat of 6; the mean difference in Beck depression inventory score was -2.63 (95% confidence interval -4.95 to -0.32), and there were significant improvements in SF-36 scores. For depression prevention, the difference in proportions of depressed participants was 14% (number needed to treat of 7); the mean difference in Beck depression inventory score was -1.50 (-4.16 to 1.17), and there were significant improvements in SF-36 scores. Such differences were not observed at 12 months. Neither specific diagnosis nor treatment with antidepressants affected outcome. Conclusions When offered to adults with depressive disorders in the community, problem solving treatment was more acceptable than the course on prevention of depression. Both interventions reduced caseness and improved subjective function.

The statistical analysis of the results of a clinical trial subject to non-compliance to allocated treatment is now reasonably straightforward through estimation of a CACE and investigators should be encouraged to present the results of analyses of this type as a routine component of a trial report.

No abstract

Depending on the way it is defined depression can be seen as a state of mood, as a symptom, as a syndrome or as a clinical diagnosis. Epidemiological studies show that depression is the most common mental disorder in man. Up to 4 % of men and 8 % of women suffer from a clinically significant depressive disorder, while depressive symptoms are much more common. The occurrence of depression is associated with factors such as age, marital status, social class, and social conditions. In Finland, only one third of persons suffering from depression are actually being treated for their disorder.