LAURA HELENA SILVEIRA GUERRA DE ANDRADE

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Instituto de Psiquiatria, Hospital das Clínicas, Faculdade de Medicina - Médico
LIM/23 - Laboratório de Psicopatologia e Terapêutica Psiquiátrica, Hospital das Clínicas, Faculdade de Medicina - Líder

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  • article 604 Citação(ões) na Scopus
    Undertreatment of people with major depressive disorder in 21 countries
    (2017) THORNICROFT, Graham; CHATTERJI, Somnath; EVANS-LACKO, Sara; GRUBER, Michael; SAMPSON, Nancy; AGUILAR-GAXIOLA, Sergio; AL-HAMZAWI, Ali; ALONSO, Jordi; ANDRADE, Laura; BORGES, Guilherme; BRUFFAERTS, Ronny; BUNTING, Brendan; ALMEIDA, Jose Miguel Caldas de; FLORESCU, Silvia; GIROLAMO, Giovanni de; GUREJE, Oye; HARO, Josep Maria; HE, Yanling; HINKOV, Hristo; KARAM, Elie; KAWAKAMI, Norito; LEE, Sing; NAVARRO-MATEU, Fernando; PIAZZA, Marina; POSADA-VILLA, Jose; GALVIS, Yolanda Torres de; KESSLER, Ronald C.
    Background Major depressive disorder (MDD) is a leading cause of disability worldwide. Aims To examine the: (a) 12-month prevalence of DSM-IV MDD; (b) proportion aware that they have a problem needing treatment and who want care; (c) proportion of the latter receiving treatment; and (d) proportion of such treatment meeting minimal standards. Method Representative community household surveys from 21 countries as part of the World Health Organization World Mental Health Surveys. Results Of 51 547 respondents, 4.6% met 12-month criteria for DSM-IV MDD and of these 56.7% reported needing treatment. Among those who recognised their need for treatment, most (71.1%) made at least one visit to a service provider. Among those who received treatment, only 41.0% received treatment that met minimal standards. This resulted in only 16.5% of all individuals with 12-month MDD receiving minimally adequate treatment. Conclusions Only a minority of participants with MDD received minimally adequate treatment: 1 in 5 people in high-income and 1 in 27 in low-/lower-middle-income countries. Scaling up care for MDD requires fundamental transformations in community education and outreach, supply of treatment and quality of services.
  • article 35 Citação(ões) na Scopus
    Complementary and alternative medicine contacts by persons with mental disorders in 25 countries: results from the World Mental Health Surveys
    (2018) JONGE, P. de; WARDENAAR, K. J.; HOENDERS, H. R.; EVANS-LACKO, S.; KOVESS-MASFETY, V.; AGUILAR-GAXIOLA, S.; AL-HAMZAWI, A.; ALONSO, J.; ANDRADE, L. H.; BENJET, C.; BROMET, E. J.; BRUFFAERTS, R.; BUNTING, B.; CALDAS-DE-ALMEIDA, J. M.; DINOLOVA, R. V.; FLORESCU, S.; GIROLAMO, G. de; GUREJE, O.; HARO, J. M.; HU, C.; HUANG, Y.; KARAM, E. G.; KARAM, G.; LEE, S.; LEPINE, J. -P.; LEVINSON, D.; MAKANJUOLA, V.; NAVARRO-MATEU, F.; PENNELL, B. -E.; POSADA-VILLA, J.; SCOTT, K.; TACHIMORI, H.; WILLIAMS, D.; WOJTYNIAK, B.; KESSLER, R. C.; THORNICROFTON, G.
    Aims.A substantial proportion of persons with mental disorders seek treatment from complementary and alternative medicine (CAM) professionals. However, data on how CAM contacts vary across countries, mental disorders and their severity, and health care settings is largely lacking. The aim was therefore to investigate the prevalence of contacts with CAM providers in a large cross-national sample of persons with 12-month mental disorders. Methods.In the World Mental Health Surveys, the Composite International Diagnostic Interview was administered to determine the presence of past 12 month mental disorders in 138 801 participants aged 18-100 derived from representative general population samples. Participants were recruited between 2001 and 2012. Rates of self-reported CAM contacts for each of the 28 surveys across 25 countries and 12 mental disorder groups were calculated for all persons with past 12-month mental disorders. Mental disorders were grouped into mood disorders, anxiety disorders or behavioural disorders, and further divided by severity levels. Satisfaction with conventional care was also compared with CAM contact satisfaction. Results. An estimated 3.6% (standard error 0.2%) of persons with a past 12-month mental disorder reported a CAM contact, which was two times higher in high-income countries (4.6%; standard error 0.3%) than in low- and middle-income countries (2.3%; standard error 0.2%). CAM contacts were largely comparable for different disorder types, but particularly high in persons receiving conventional care (8.6-17.8%). CAM contacts increased with increasing mental disorder severity. Among persons receiving specialist mental health care, CAM contacts were reported by 14.0% for severe mood disorders, 16.2% for severe anxiety disorders and 22.5% for severe behavioural disorders. Satisfaction with care was comparable with respect to CAM contacts (78.3%) and conventional care (75.6%) in persons that received both. Conclusions.CAM contacts are common in persons with severe mental disorders, in high-income countries, and in persons receiving conventional care. Our findings support the notion of CAM as largely complementary but are in contrast to suggestions that this concerns person with only mild, transient complaints. There was no indication that persons were less satisfied by CAM visits than by receiving conventional care. We encourage health care professionals in conventional settings to openly discuss the care patients are receiving, whether conventional or not, and their reasons for doing so.
  • article 19 Citação(ões) na Scopus
    Patterns and correlates of patient-reported helpfulness of treatment for common mental and substance use disorders in the WHO World Mental Health Surveys
    (2022) KESSLER, Ronald C.; KAZDIN, Alan E.; AGUILAR-GAXIOLA, Sergio; AL-HAMZAWI, Ali; ALONSO, Jordi; ALTWAIJRI, Yasmin A.; ANDRADE, Laura H.; BENJET, Corina; BHARAT, Chrianna; BORGES, Guilherme; BRUFFAERTS, Ronny; BUNTING, Brendan; ALMEIDA, Jose Miguel Caldas; CARDOSO, Graca; CHIU, Wai Tat; CIA, Alfredo; CIUTAN, Marius; DEGENHARDT, Louisa; GIROLAMO, Giovanni; JONGE, Peter; VRIES, Ymkje Anna; FLORESCU, Silvia; GUREJE, Oye; HARO, Josep Maria; HARRIS, Meredith G.; HU, Chiyi; KARAM, Aimee N.; KARAM, Elie G.; KARAM, Georges; KAWAKAMI, Norito; KIEJNA, Andrzej; KOVESS-MASFETY, Viviane; LEE, Sing; MAKANJUOLA, Victor; MCGRATH, John J.; MEDINA-MORA, Maria Elena; MOSKALEWICZ, Jacek; NAVARRO-MATEU, Fernando; NIERENBERG, Andrew A.; NISHI, Daisuke; OJAGBEMI, Akin; OLADEJI, Bibilola D.; O'NEILL, Siobhan; POSADA-VILLA, Jose; PUAC-POLANCO, Victor; RAPSEY, Charlene; RUSCIO, Ayelet Meron; SAMPSON, Nancy A.; SCOTT, Kate M.; SLADE, Tim; STAGNARO, Juan Carlos; STEIN, Dan J.; TACHIMORI, Hisateru; HAVE, Margreet; TORRES, Yolanda; VIANA, Maria Carmen; VIGO, Daniel V.; WILLIAMS, David R.; WOJTYNIAK, Bogdan; XAVIER, Miguel; ZARKOV, Zahari; ZIOBROWSKI, Hannah N.
    Patient-reported helpfulness of treatment is an important indicator of quality in patient-centered care. We examined its pathways and predictors among respondents to household surveys who reported ever receiving treatment for major depression, generalized anxiety disorder, social phobia, specific phobia, post-traumatic stress disorder, bipolar disorder, or alcohol use disorder. Data came from 30 community epidemiological surveys - 17 in high-income countries (HICs) and 13 in low- and middle-income countries (LMICs) - carried out as part of the World Health Organization (WHO)'s World Mental Health (WMH) Surveys. Respondents were asked whether treatment of each disorder was ever helpful and, if so, the number of professionals seen before receiving helpful treatment. Across all surveys and diagnostic categories, 26.1% of patients (N=10,035) reported being helped by the very first professional they saw. Persisting to a second professional after a first unhelpful treatment brought the cumulative probability of receiving helpful treatment to 51.2%. If patients persisted with up through eight professionals, the cumulative probability rose to 90.6%. However, only an estimated 22.8% of patients would have persisted in seeing these many professionals after repeatedly receiving treatments they considered not helpful. Although the proportion of individuals with disorders who sought treatment was higher and they were more persistent in HICs than LMICs, proportional helpfulness among treated cases was no different between HICs and LMICs. A wide range of predictors of perceived treatment helpfulness were found, some of them consistent across diagnostic categories and others unique to specific disorders. These results provide novel information about patient evaluations of treatment across diagnoses and countries varying in income level, and suggest that a critical issue in improving the quality of care for mental disorders should be fostering persistence in professional help-seeking if earlier treatments are not helpful.
  • article 11 Citação(ões) na Scopus
    Perceived helpfulness of treatment for specific phobia: Findings from the World Mental Health Surveys
    (2021) VRIES, Ymkje Anna de; HARRIS, Meredith G.; VIGO, Daniel; CHIU, Wai Tat; SAMPSON, Nancy A.; AL-HAMZAWI, Ali; ALONSO, Jordi; ANDRADE, Laura H.; BENJET, Corina; BRUFFAERTS, Ronny; BUNTING, Brendan; ALMEIDA, Jose Miguel Caldas de; GIROLAMO, Giovanni de; FLORESCU, Silvia; GUREJE, Oye; HARO, Josep Maria; HU, Chiyi; KARAM, Elie G.; KAWAKAMI, Norito; KOVESS-MASFETY, Viviane; LEE, Sing; MOSKALEWICZ, Jacek; NAVARRO-MATEU, Fernando; OJAGBEMI, Akin; VILLA, Jose Pusada; SCOTT, Kate; TORRES, Yola; ZARKOV, Zahari; NIERENBERG, Andrew; KESSLER, Ronald C.; JONGE, Peter de
    Background: Although randomized trials show that specific phobia treatments can be effective, it is unclear whether patients experience treatment as helpful in clinical practice. We investigated this issue by assessing perceived treatment helpfulness for specific phobia in a cross-national epidemiological survey. Methods: Cross-sectional population-based WHO World Mental Health (WMH) surveys in 24 countries (n=112,507) assessed lifetime specific phobia. Respondents who met lifetime criteria were asked whether they ever received treatment they considered helpful and the number of professionals seen up to the time of receiving helpful treatment. Discrete-event survival analysis was used to calculate conditional-cumulative probabilities of obtaining helpful treatment across number of professionals seen and of persisting in help-seeking after prior unhelpful treatment. Results: 23.0% of respondents reported receiving helpful treatment from the first professional seen, whereas cumulative probability of receiving helpful treatment was 85.7% after seeing up to 9 professionals. However, only 14.7% of patients persisted in seeing up to 9 professionals, resulting in the proportion of patients ever receiving helpful treatment (47.5%) being much lower than it could have been with persistence in help-seeking. Few predictors were found either of perceived helpfulness or of persistence in help-seeking after earlier unhelpful treatments. Limitations: Retrospective recall and lack of information about either types of treatments received or objective symptomatic improvements limit results. Conclusions: Despite these limitations, results suggest that helpfulness of specific phobia treatment could be increased, perhaps substantially, by increasing patient persistence in help-seeking after earlier unhelpful treatments. Improved understanding is needed of barriers to help-seeking persistence.
  • article 7 Citação(ões) na Scopus
    Dropout from treatment for mental disorders in six countries of the Americas: A regional report from the World Mental Health Surveys
    (2022) BENJET, Corina; BORGES, Guilherme; OROZCO, Ricardo; AGUILAR-GAXIOLA, Sergio; ANDRADE, Laura H.; CIA, Alfredo; HWANG, Irving; KESSLER, Ronald C.; PIAZZA, Marina; POSADA-VILLA, Jose; SAMPSON, Nancy; STAGNARO, Juan Carlos; TORRES, Yolanda; VIANA, Maria Carmen; VIGO, Daniel; MEDINA-MORA, Maria-Elena
    Objective: To estimate structural and attitudinal reasons for premature discontinuation of mental health treatment, socio-demographic and clinical correlates of treatment dropout due to these reasons, and to test country differences from the overall effect across the region of the Americas. Methods: World Health Organization-World Mental Health (WMH) surveys were carried out in six countries in the Americas: Argentina, Brazil, Colombia, Mexico, Peru and USA. Among the 1991 participants who met diagnostic criteria (measured with the Composite International Diagnostic Interview (WMH-CIDI)) for a mental disorder and were in treatment in the prior 12-months, the 236 (12.2%) who dropped out of treatment before the professional recommended were included. Findings: In all countries, individuals more frequently reported attitudinal (79.2%) rather than structural reasons (30.7%) for dropout. Disorder severity was associated with structural reasons; those with severe disorder (versus mild disorder) had 3.4 (95%CI=1.1-11.1) times the odds of reporting a structural reason. Regarding attitudinal reasons, those with lower income (versus higher income) were less likely to discontinue treatment because of getting better (OR=0.4; 95%CI= 0.2-0.9). Country specific variations were found. Limitations: Not all countries, or the poorest, in the region were included. Some estimations couldn't be calculated due to cell size. Causality cannot be assumed. Conclusion: Clinicians should in the first sessions address attitudinal factors that may lead to premature termination. Public policies need to consider distribution of services to increase convenience. A more rational use of resources would be to offer brief therapies to individuals most likely to drop out of treatment prematurely.
  • article 7 Citação(ões) na Scopus
    Perceived helpfulness of treatment for social anxiety disorder: findings from the WHO World Mental Health Surveys
    (2022) BRUFFAERTS, Ronny; HARRIS, Meredith G.; KAZDIN, Alan E.; VIGO, Daniel V.; SAMPSON, Nancy A.; CHIU, Wai Tat; AL-HAMZAWI, Ali; ALONSO, Jordi; ALTWAIJRI, Yasmin A.; ANDRADE, Laura; BENJET, Corina; GIROLAMO, Giovanni de; FLORESCU, Silvia; HARO, Josep Maria; HU, Chi-Yi; KARAM, Aimee; KARAM, Elie G.; KOVESS-MASFETY, Viviane; LEE, Sing; MCGRATH, John J.; NAVARRO-MATEU, Fernando; NISHI, Daisuke; O'NEILL, Siobhan; POSADA-VILLA, Jose; SCOTT, Kate M.; HAVE, Margreet Ten; TORRES, Yolanda; WOJTYNIAK, Bogdan; XAVIER, Miguel; ZARKOV, Zahari; KESSLER, Ronald C.
    Purpose To investigate the prevalence and predictors of perceived helpfulness of treatment in persons with a history of DSM-IV social anxiety disorder (SAD), using a worldwide population-based sample. Methods The World Health Organization World Mental Health Surveys is a coordinated series of community epidemiological surveys of non-institutionalized adults; 27 surveys in 24 countries (16 in high-income; 11 in low/middle-income countries; N = 117,856) included people with a lifetime history of treated SAD. Results In respondents with lifetime SAD, approximately one in five ever obtained treatment. Among these (n = 1322), cumulative probability of receiving treatment they regarded as helpful after seeing up to seven professionals was 92.2%. However, only 30.2% persisted this long, resulting in 65.1% ever receiving treatment perceived as helpful. Perceiving treatment as helpful was more common in female respondents, those currently married, more highly educated, and treated in non-formal health-care settings. Persistence in seeking treatment for SAD was higher among those with shorter delays in seeking treatment, in those receiving medication from a mental health specialist, and those with more than two lifetime anxiety disorders. Conclusions The vast majority of individuals with SAD do not receive any treatment. Among those who do, the probability that people treated for SAD obtain treatment they consider helpful increases considerably if they persisted in help-seeking after earlier unhelpful treatments.
  • article 299 Citação(ões) na Scopus
    Treatment gap for anxiety disorders is global: Results of the World Mental Health Surveys in 21 countries
    (2018) ALONSO, Jordi; LIU, Zhaorui; EVANS-LACKO, Sara; SADIKOVA, Ekaterina; SAMPSON, Nancy; CHATTERJI, Somnath; ABDULMALIK, Jibril; AGUILAR-GAXIOLA, Sergio; AL-HAMZAWI, Ali; ANDRADE, Laura H.; BRUFFAERTS, Ronny; CARDOSO, Graca; CIA, Alfredo; FLORESCU, Silvia; GIROLAMO, Giovanni de; GUREJE, Oye; HARO, Josep M.; HE, Yanling; JONGE, Peter de; KARAM, Elie G.; KAWAKAMI, Norito; KOVESS-MASFETY, Viviane; LEE, Sing; LEVINSON, Daphna; MEDINA-MORA, Maria Elena; NAVARRO-MATEU, Fernando; PENNELL, Beth-Ellen; PIAZZA, Marina; POSADA-VILLA, Jose; HAVE, Margreet ten; ZARKOV, Zahari; KESSLER, Ronald C.; THORNICROFT, Graham
    Background: Anxiety disorders are a major cause of burden of disease. Treatment gaps have been described, but a worldwide evaluation is lacking. We estimated, among individuals with a 12-month DSM-IV (where DSM is Diagnostic Statistical Manual) anxiety disorder in 21 countries, the proportion who (i) perceived a need for treatment; (ii) received any treatment; and (iii) received possibly adequate treatment. Methods: Data from 23 community surveys in 21 countries of the World Mental Health (WMH) surveys. DSM-IV mental disorders were assessed (WHO Composite International Diagnostic Interview, CIDI 3.0). DSM-IV included posttraumatic stress disorder among anxiety disorders, while it is not considered so in the DSM-5. We asked if, in the previous 12 months, respondents felt they needed professional treatment and if they obtained professional treatment (specialized/general medical, complementary alternative medical, or nonmedical professional) for ""problems with emotions, nerves, mental health, or use of alcohol or drugs."" Possibly adequate treatment was defined as receiving pharmacotherapy (1+ months of medication and 4+ visits to a medical doctor) or psychotherapy, complementary alternative medicine or nonmedical care (8+ visits). Results: Of 51,547 respondents (response = 71.3%), 9.8% had a 12-month DSM-IV anxiety disorder, 27.6% of whom received any treatment, and only 9.8% received possibly adequate treatment. Of those with 12-month anxiety only 41.3% perceived a need for care. Lower treatment levels were found for lower income countries. Conclusions: Low levels of service use and a high proportion of those receiving services not meeting adequacy standards for anxiety disorders exist worldwide. Results suggest the need for improving recognition of anxiety disorders and the quality of treatment.
  • article 12 Citação(ões) na Scopus
    Antidepressant use in low- middle- and high-income countries: a World Mental Health Surveys report
    (2023) KAZDIN, Alan E.; WU, Chi-Shin; HWANG, Irving; PUAC-POLANCO, Victor; SAMPSON, Nancy A.; AL-HAMZAWI, Ali; ALONSO, Jordi; ANDRADE, Laura Helena; BENJET, Corina; CALDAS-DE-ALMEIDA, Jose-Miguel; GIROLAMO, Giovanni de; JONGE, Peter de; FLORESCU, Silvia; GUREJE, Oye; HARO, Josep M.; HARRIS, Meredith G.; KARAM, Elie G.; KARAM, Georges; KOVESS-MASFETY, Viviane; LEE, Sing; MCGRATH, John J.; NAVARRO-MATEU, Fernando; NISHI, Daisuke; OLADEJI, Bibilola D.; POSADA-VILLA, Jose; STEIN, Dan J.; USTUN, T. Bedirhan; VIGO, Daniel V.; ZARKOV, Zahari; ZASLAVSKY, Alan M.; KESSLER, Ronald C.
    Background The most common treatment for major depressive disorder (MDD) is antidepressant medication (ADM). Results are reported on frequency of ADM use, reasons for use, and perceived effectiveness of use in general population surveys across 20 countries. Methods Face-to-face interviews with community samples totaling n = 49 919 respondents in the World Health Organization (WHO) World Mental Health (WMH) Surveys asked about ADM use anytime in the prior 12 months in conjunction with validated fully structured diagnostic interviews. Treatment questions were administered independently of diagnoses and asked of all respondents. Results 3.1% of respondents reported ADM use within the past 12 months. In high-income countries (HICs), depression (49.2%) and anxiety (36.4%) were the most common reasons for use. In low- and middle-income countries (LMICs), depression (38.4%) and sleep problems (31.9%) were the most common reasons for use. Prevalence of use was 2-4 times as high in HICs as LMICs across all examined diagnoses. Newer ADMs were proportionally used more often in HICs than LMICs. Across all conditions, ADMs were reported as very effective by 58.8% of users and somewhat effective by an additional 28.3% of users, with both proportions higher in LMICs than HICs. Neither ADM class nor reason for use was a significant predictor of perceived effectiveness. Conclusion ADMs are in widespread use and for a variety of conditions including but going beyond depression and anxiety. In a general population sample from multiple LMICs and HICs, ADMs were widely perceived to be either very or somewhat effective by the people who use them.
  • article 4 Citação(ões) na Scopus
    Determinants of effective treatment coverage for posttraumatic stress disorder: findings from the World Mental Health Surveys
    (2023) STEIN, Dan J.; KAZDIN, Alan E.; MUNTHALI, Richard J.; HWANG, Irving; HARRIS, Meredith G.; ALONSO, Jordi; ANDRADE, Laura Helena; BRUFFAERTS, Ronny; CARDOSO, Graca; CHARDOUL, Stephanie; GIROLAMO, Giovanni de; FLORESCU, Silvia; GUREJE, Oye; HARO, Josep Maria; KARAM, Aimee N.; KARAM, Elie G.; KOVESS-MASFETY, Viviane; LEE, Sing; MEDINA-MORA, Maria Elena; NAVARRO-MATEU, Fernando; POSADA-VILLA, Jose; STAGNARO, Juan Carlos; HAVE, Margree ten; SAMPSON, Nancy A.; KESSLER, Ronald C.; VIGO, Daniel V.
    BackgroundPosttraumatic stress disorder (PTSD) is associated with significant morbidity, but efficacious pharmacotherapy and psychotherapy are available. Data from the World Mental Health Surveys were used to investigate extent and predictors of treatment coverage for PTSD in high-income countries (HICs) as well as in low- and middle-income countries (LMICs).MethodsSeventeen surveys were conducted across 15 countries (9 HICs, 6 LMICs) by the World Health Organization (WHO) World Mental Health Surveys. Of 35,012 respondents, 914 met DSM-IV criteria for 12-month PTSD. Components of treatment coverage analyzed were: (a) any mental health service utilization; (b) adequate pharmacotherapy; (c) adequate psychotherapy; and (d) effective treatment coverage. Regression models investigated predictors of treatment coverage.Results12-month PTSD prevalence in trauma exposed individuals was 1.49 (S.E., 0.08). A total of 43.0% (S.E., 2.2) received any mental health services, with fewer receiving adequate pharmacotherapy (13.5%), adequate psychotherapy (17.2%), or effective treatment coverage (14.4%), and with all components of treatment coverage lower in LMICs than HICs. In a multivariable model having insurance (OR = 2.31, 95 CI 1.17, 4.57) and severity of symptoms (OR = .35, 95% CI 0.18, 0.70) were predictive of effective treatment coverage.ConclusionThere is a clear need to improve pharmacotherapy and psychotherapy coverage for PTSD, particularly in those with mild symptoms, and especially in LMICs. Universal health care insurance can be expected to increase effective treatment coverage and therefore improve outcomes.
  • article 1445 Citação(ões) na Scopus
    Cross-national epidemiology of DSM-IV major depressive episode
    (2011) BROMET, Evelyn; ANDRADE, Laura Helena; HWANG, Irving; SAMPSON, Nancy A.; ALONSO, Jordi; GIROLAMO, Giovanni de; GRAAF, Ron de; DEMYTTENAERE, Koen; HU, Chiyi; IWATA, Noboru; KARAM, Aimee N.; KAUR, Jagdish; KOSTYUCHENKO, Stanislav; LEPINE, Jean-Pierre; LEVINSON, Daphna; MATSCHINGER, Herbert; MORA, Maria Elena Medina; BROWNE, Mark Oakley; POSADA-VILLA, Jose; VIANA, Maria Carmen; WILLIAMS, David R.; KESSLER, Ronald C.
    Background: Major depression is one of the leading causes of disability worldwide, yet epidemiologic data are not available for many countries, particularly low- to middle-income countries. In this paper, we present data on the prevalence, impairment and demographic correlates of depression from 18 high and low-to middle-income countries in the World Mental Health Survey Initiative. Methods: Major depressive episodes (MDE) as defined by the Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DMS-IV) were evaluated in face-to-face interviews using the World Health Organization Composite International Diagnostic Interview (CIDI). Data from 18 countries were analyzed in this report (n = 89,037). All countries surveyed representative, population-based samples of adults. Results: The average lifetime and 12-month prevalence estimates of DSM-IV MDE were 14.6% and 5.5% in the ten high-income and 11.1% and 5.9% in the eight low- to middle-income countries. The average age of onset ascertained retrospectively was 25.7 in the high-income and 24.0 in low- to middle-income countries. Functional impairment was associated with recency of MDE. The female: male ratio was about 2: 1. In high-income countries, younger age was associated with higher 12-month prevalence; by contrast, in several low-to middle-income countries, older age was associated with greater likelihood of MDE. The strongest demographic correlate in high-income countries was being separated from a partner, and in low- to middle-income countries, was being divorced or widowed. Conclusions: MDE is a significant public-health concern across all regions of the world and is strongly linked to social conditions. Future research is needed to investigate the combination of demographic risk factors that are most strongly associated with MDE in the specific countries included in the WMH.