Vascular depression prevalence and epidemiology in the United States

Objective: To examine and describe vascular depression epidemiology in the United States. Methods: Cross-sectional data from a national probability sample of household resident adults (18-years and older; N = 16,423) living in the 48 coterminous United States were analyzed to calculate prevalence estimates of vascular depression, associated disability and treatment rates. In this study, vascular depression was defined as the presence of cardiovascular and cerebrovascular disease (CVD) and CVD major risk factors (e.g., diabetes, hypertension, heart disease, and obesity) among adults 50-years and older who also met 12-month DSM-IV major depression criteria. Results: We estimated that about 3.4% or approximately 2.64 million American adults 50-years and older met our criteria for vascular depression. Among adults who met criteria for lifetime major depression, over one-in-five (22.1%) were considered to have the vascular depression subtype. Secondly, vascular depression was associated with significantly increased functional impairment relative to the non-depressed population and adults meeting criteria for major depression alone. Although depression care use was significantly higher among vascular depression respondents relative to those with major depression alone, practice guideline concordant therapy use was not. Conclusions: Vascular depression appears to be an important public health problem that affects a large portion of the U.S. adult population with major depression, and that it is associated with excess functional impairment without concomitant better depression care.