Lifetime and current depression in the German National Cohort (NAKO)

Figures & data

Table 1. Description of depression symptoms and diagnosis criteria as per the DSM-IV.

Criterion	Description
A1	Depressed mood
A2	Diminished interest or pleasure in most or all activities
A3	Significant weight change or change in appetite
A4	Change in sleep (e.g. insomnia or hypersomnia)
A5	Change in activity (e.g. psychomotor retardation)
A6	Fatigue or loss of energy
A7	Feelings of worthlessness or excessive or inappropriate guilt
A8	Problems with concentration or decision-making
A9	Recurrent thoughts of death, or suicidal ideation, plan, or attempt
Criterion A	Depressive symptomatology: ≥1 symptom of A1 or A2, and ≥5 symptoms of A1 to A9
Criterion B	Exclusion of bipolar disorder as the cause
Criterion C	Clinically significant distress or impairment in functioning
Criterion D	Exclusion of substance abuse or a general medical condition as the cause
Criterion E	Exclusion of bereavement as the cause

DSM-IV: Diagnostic and Statistical Manual of Mental Disorders 4th edition.

Table 2. Descriptive statistics of demographic and depression measures in the NAKO.

	Valid n	Total (n = 101,667)	Women (n = 54,463)	Men (n = 47,204)
Demographics
Age in years	101,667	52.0 (12.4)	51.5 (12.4)	52.5 (12.3)
Living with partner	101,502	76.0%	72.4%	80.1%
Born in Germany	101,648	88.7%	88.6%	88.9%
MINI Interview (all participants)
MINI Screen positive	100,719	27.4%	31.7%	22.5%
MINI Interview (L2 only)
MINI Screen positive L2	26,261	26.1%	30.6%	21.3%
Criterion A positive	25,671	19.1%	23.4%	14.5%
NAKO MINI Classification positive	25,626	15.9%	19.4%	12.2%
Age at onset^a	4,053	36.4 (13.5)	35.8 (13.7)	37.3 (13.4)
Years since onset of last episode^a	4,007	6.7 (8.0)	6.3 (7.8)	7.3 (8.4)
Physician’s diagnosis of depression
Lifetime diagnosis Depression	101,048	15.0%	19.0%	10.4%
Age at onset^b	14,925	41.0 (12.5)	40.4 (12.4)	42.4 (12.6)
Depression treatment last 12 months	101,034	7.1%	9.3%	4.7%
Family history of depression
Depression mother	78,038	14.3%	16.2%	12.2%
Depression father	72,224	7.6%	8.8%	6.6%
PHQ-9
Sum score	93,242	3.9 (3.7)	4.4 (3.9)	3.4 (3.5)
Sum score ≥ 10	93,242	7.8%	9.4%	6.1%
Diagnostic algorithm
Major Depressive Syndrome	93,242	2.9%	3.4%	2.4%
Other Depressive Syndrome	93,242	2.9%	3.0%	2.7%
Impairment^c	7,275	1.5 (0.7)	1.5 (0.7)	1.5 (0.8)

For continuous measures, mean and standard deviation (SD) are given; for categorical variables, the frequency is given in percent. Data is shown for the whole sample, and for women and men separately. N = total number of participants in the sample. n = number of participants for which the valid values of respective measure were available. L2 = variable reported for L2 subsample. a = data presented for the L2 participants with a positive NAKO MINI Classification. b = data presented for participants with a lifetime physician’s diagnosis of depression, c = data presented for participants with PHQ-9 score ≥ 10. MINI = Mini-International Neuropsychiatric Interview. NAKO = German National Cohort. PHQ-9 = Depression Scale of the Patient Health Questionnaire (PHQ-9). Based on (NAKO data freeze 100,000; application NAKO-399).

Figure 1. Smoothed estimates of mean of Current (A) PHQ-9 and (B) PHQ-Stress Ratings and Frequency of Lifetime (C) NAKO MINI Classification and (D) Physician’s Diagnosis of Depression by Sex and Age. Note. The grey areas represent the 95% confidence interval. MINI = Mini-International Neuropsychiatric Interview. NAKO = German National Cohort. PHQ-9 = Depression Scale of the Patient Health Questionnaire (PHQ-9). Based on (NAKO data freeze 100,000; application NAKO-399).

Table 3. Descriptive statistics of depression measures by Age Group in the NAKO.

	Age group
	20–29	30–39	40–49	50–59	60–72
N	7,080	9,591	22,046	29,363	33587
MINI Screen	21.8%	24.5%	27.9%	31.9%	25.2%
NAKO MINI Classification^a	11.7%	13.7%	15.9%	19.4%	14.0%
Physician’s Diagnosis	8.0%	11.8%	14.3%	17.7%	15.4%
Treatment last 12 months	4.5%	5.9%	7.1%	9.1%	6.3%
Family History
One Parent	15.2%	17.8%	16.7%	17.3%	14.7%
Both Parents	2.4%	1.9%	2.1%	2.2%	1.8%
PHQ-9 ≥ 10	10.0%	8.5%	8.1%	9.3%	5.5%
PHQ-9 sum core	4.5 (3.9)	4.2 (3.8)	4.0 (3.8)	4.2 (4.0)	3.3 (3.4)
PHQ-Stress sum score	3.5 (2.9)	3.8 (3.1)	3.9 (3.3)	3.9 (3.3)	3.1 (2.9)
GAD-7 sum score	3.5 (3.4)	3.5 (3.3)	3.4 (3.3)	3.4 (3.4)	2.7 (2.9)

For continuous measures mean and standard deviation (SD) is given; for categorical variables, the frequency is given in percent. n = number of participants in the respective age group. a = variable only available in/reported for L2 subset. MINI = Mini-International Neuropsychiatric Interview. NAKO = German National Cohort. PHQ-9 = Depression Scale of the Patient Health Questionnaire. GAD-7 = Generalized Anxiety Disorder 7 scale. Based on (NAKO data freeze 100,000; application NAKO-399).

Table 4. Descriptive statistics of depression measures by ISCED-97 education level in the NAKO.

		Education Level
	n	Lower	Intermediate	Higher
Number of participants	92,742	2,723	39,828	50,191
MINI Screen	91,901	33.5%	28.0%	26.0%
NAKO MINI Classification^a	23,547	20.6%	16.6%	14.6%
Physician’s Diagnosis	92,187	23.4%	15.9%	13.4%
Treatment last 12 months	92,169	12.4%	8.0%	6.0%
Family history	62,439
One Parent		14.6%	15.4%	16.9%
Both Parents		3.3%	2.0%	1.9%
PHQ-9 ≥ 10	85,185	18.2%	9.4%	5.8%
PHQ-9 sum score	85,185	5.6 (5.2)	4.2 (4.0)	3.6 (3.4)
PHQ-Stress sum score	84,681	4.7 (4.1)	3.8 (3.3)	3.4 (2.9)
GAD-7 sums score	84,969	4.22 (4.29)	3.35 (3.44)	2.96 (2.97)

For continuous measures mean and standard deviation (SD) is given; for categorical variables, the frequency is given in percent. a = variable only reported for L2 subset. n = number of participants for which the valid values of respective measure were available. ISCED97 = International Standard Classification of Education 97. MINI = Mini-International Neuropsychiatric Interview. NAKO = German National Cohort. PHQ-9 = Depression Scale of the Patient Health Questionnaire (PHQ-9). GAD-7 = Generalized Anxiety Disorder 7 scale. Based on (NAKO data freeze 100,000; application NAKO-399).

Figure 2. Frequency of physician’s diagnosis of depression (lifetime), positive MINI screen (lifetime), and PHQ-9 ≥ 10 (4 weeks) by Study Centre. Note. MINI = Mini-International Neuropsychiatric Interview. NAKO = German National Cohort. PHQ-9 = Depression Scale of the Patient Health Questionnaire (PHQ-9). Based on (NAKO data freeze 100,000; application NAKO-399).

Figure 3. (A) Odds Ratio and 95% confidence interval for measures of depression by reported family history of depression. (B) Distribution of PHQ-9 and PHQ-stress mean scores and 95% confidence interval by Reported Family History of Depression in the NAKO. Note. Participants reporting no history of depression in their parents are presented as the reference group (blue). Estimates are adjusted for age, sex and education level (lower/intermediate/higher). MINI = Mini-International Neuropsychiatric Interview. NAKO = German National Cohort. PHQ-9 = Depression Scale of the Patient Health Questionnaire (PHQ-9). n = subjects with complete data included in the respective analysis. Based on (NAKO data freeze 100,000; application NAKO-399).

Table 5. Proportion of positive diagnosis or screening and mean of depression measures (columns) for participants negative or positive for the different categorical depression measures (rows) in the NAKO.

	MINI Screen	NAKO MINI Classification^a	Physician’s Diagnosis	Treatment last 12 months	PHQ-9  ≥ 10	PHQ-9 sum score	PHQ-Stress sum score	GAD-7 sum score
Time frame	Lifetime			Last 12 months	Last 2 weeks		Last 4 weeks
Total sample	27.4%	15.9%	15.0%	7.1%	7.8%	3.9 (3.7)	3.6 (3.1)	3.2 (3.2)
MINI Screen negative	–	0.0%	3.8%	1.6%	3.1%	3.0 (2.8)	3.0 (2.7)	2.5 (2.6)
MINI Screen positive	–	65.5%	44.7%	21.9%	20.3%	6.2 (4.8)	5.3 (3.7)	5.0 (4.0)
NAKO MINI Classification negative^a	9.9%	–	5.5%	2.3%	3.9%	3.2 (3.0)	3.1 (2.7)	2.6 (2.7)
NAKO MINI Classification positive^a	100.0%	–	56.2%	28.3%	24.5%	6.8 (5.1)	5.7 (3.8)	5.7 (4.3)
Physician’s Diagnosis negative	17.7%	8.0%	–	0.0%	4.3%	3.3 (3.1)	3.2 (2.8)	2.7 (2.7)
Physician’s Diagnosis positive	81.6%	65.8%	–	47.6%	27.7%	7.2 (5.3)	5.9 (3.9)	5.8 (4.4)
No treatment last 12 months	22.9%	12.1%	8.4%	–	5.3%	3.5 (3.2)	3.4 (2.9)	2.9 (2.9)
Treatment last 12 months	83.7%	69.4%	100.0%	–	41.0%	9.0 (5.7)	7.0 (4.1)	7.2 (4.7)
PHQ-9 < 10	23.7%	12.8%	11.6%	4.5%	–	3.1 (2.4)	3.2 (2.7)	2.6 (2.5)
PHQ-9 ≥ 10	71.4%	54.0%	52.7%	36.9%	–	13.4 (3.5)	8.7 (3.7)	9.6 (4.3)

For continuous measures mean and standard deviation (SD) is given, for categorical variables, the frequency is given in percent. For the number of subjects with available data see Supplementary Table S 5. a = variable only reported for L2 subset. MINI = Mini-International Neuropsychiatric Interview. NAKO = German National Cohort. PHQ-9 = Depression Scale of the Patient Health Questionnaire (PHQ-9). Based on (NAKO data freeze 100,000; application NAKO-399).

Table

Studienzentrum Kiel:	Wolfgang Lieb^1
Studienzentrum Hamburg:	Heiko Becher^2; Nadia Obi^2
Studienzentrum Bremen:	Hajo Zeeb^3,4; Wolfgang Ahrens^3,5
Studienzentrum Hannover:	Stefanie Castell^6; Yvonne Kemmling^6
Studienzentrum Münster:	André Karch^7; Nicole Rübsamen^7
Studienzentrum Essen:	Carina Emmel^8; Karl-Heinz Jöckel^8
Studienzentrum Saarbrücken:	Laura Perna^9,10; Hermann Brenner^10,11
Studienzentrum Mannheim:	Rudolph Kaaks^12; Karin Halina Greiser^12
Studienzentrum Freiburg:	Karin B. Michels^13; Claus-Werner Franzke^13
Studienzentrum Augsburg:	Annette Peters^14,15
Studienzentrum Regensburg:	Beate Fischer^16; Michael Leitzmann^16
Studienzentrum Halle:	Führer, Amand^17; Rafael Mikolajczyk^17
Studienzentrum Berlin-Mitte:	Thomas Keil^18,19,20; Julia Fricke^18
Studienzentrum Berlin-Nord:	Insa Feinkohl^21; Tobias Pischon^21,22,23,24
Studienzentrum Neubrandenburg:	Sabine Schipf^25; Wolfgang Hoffmann^26,27

¹Institute of Epidemiology, Kiel University, Kiel, Germany; ([e-mail])

²Institute of Medical Biometry and Epidemiology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany ([e-mail], [e-mail])

³Leibniz-Institut für Präventionsforschung und Epidemiologie – BIPS, Bremen, Deutschland

⁴Health Sciences Bremen, Universität Bremen, Bremen, Deutschland

⁵Institut für Statistik, Fachbereich Mathematik und Informatik, Universität Bremen, Bremen, Deutschland

⁶Department for Epidemiology, Helmholtz Centre for Infection Research (HZI), Braunschweig, Germany ([e-mail]; [e-mail])

⁷Institute of Epidemiology and Social Medicine, University of Muenster, Muenster, Germany ([e-mail]; [e-mail])

⁸Institute for Medical Informatics, Biometry and Epidemiology, University of Duisburg-Essen, Germany ([e-mail]; [e-mail])

⁹Department of Translational Research in Psychiatry, Max Planck Institute of Psychiatry, Munich, Germany. ([e-mail])

¹⁰Division of Clinical Epidemiology & Ageing Research, German Cancer Research Centre (DKFZ), Heidelberg, Germany ([e-mail])

¹¹Network Ageing Research (NAR), Heidelberg University, Heidelberg, Germany

¹²German Cancer Research Centre (DKFZ) Heidelberg, Div. of Cancer Epidemiology, Heidelberg, Germany; ([e-mail])

¹³Institute for Prevention and Cancer Epidemiology, Faculty of Medicine and Medical Centre, University of Freiburg, Freiburg, Germany ([e-mail], [e-mail])

¹⁴Institute of Epidemiology, Helmholtz Zentrum München, German Research Centre for Environmental Health, 85764 Neuherberg, Germany ([e-mail])

¹⁵Chair of Epidemiology, Institute for Medical Information Processing, Biometry and Epidemiology, Medical Faculty, Ludwig-Maximilians-Universität München, 81377 Munich, Germany

¹⁶Department of Epidemiology and Preventive Medicine, University of Regensburg; ([e-mail], [e-mail])

¹⁷Institute for Medical Epidemiology, Biometrics and Informatics (IMEBI), Interdisciplinary Centre for Health Sciences, Medical School of the Martin Luther University Halle-Wittenberg ([e-mail], [e-mail])

¹⁸Institute of Social Medicine, Epidemiology and Health Economics, Charité-Universitätsmedizin Berlin, Berlin, Germany ([e-mail], [e-mail])

¹⁹Institute for Clinical Epidemiology and Biometry, University of Wuerzburg, Wuerzburg

²⁰State Institute of Health, Bavarian Health and Food Safety Authority, Bad Kissingen, Germany

²¹Max-Delbrueck-Centre for Molecular Medicine in the Helmholtz Association (MDC), Molecular Epidemiology Research Group, Berlin, Germany ([e-mail]; [e-mail])

²²Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany

²³Max-Delbrueck-Centre for Molecular Medicine in the Helmholtz Association (MDC), Biobank Technology Platform, Berlin, Germany

²⁴Berlin Institute of Health at Charité – Universitätsmedizin Berlin, Core Facility Biobank, Berlin, German

²⁵Institute for Community Medicine, University Medicine Greifswald, Germany ([e-mail])

²⁶Institute for Community Medicine, Section Epidemiology of Health Care and Community Health, University Medicine Greifswald (UMG), Ellernholzstrasse 1-2, Greifswald D-17487, Germany; ([e-mail])

²⁷German Centre for Neurodegenerative Diseases (DZNE) Site Rostock/Greifswald, Ellernholzstrasse 1-2, Greifswald D-17487, Germany