Importance No US national data are available on the prevalence and correlates of DSM-5–defined major depressive disorder (MDD) or on MDD specifiers as defined in DSM-5.

Objective To present current nationally representative findings on the prevalence, correlates, psychiatric comorbidity, functioning, and treatment of DSM-5 MDD and initial information on the prevalence, severity, and treatment of DSM-5 MDD severity, anxious/distressed specifier, and mixed-features specifier, as well as cases that would have been characterized as bereavement in DSM-IV.

Design, Setting, and Participants In-person interviews with a representative sample of US noninstitutionalized civilian adults (≥18 years) (n = 36 309) who participated in the 2012-2013 National Epidemiologic Survey on Alcohol and Related Conditions III (NESARC-III). Data were collected from April 2012 to June 2013 and were analyzed in 2016-2017.

Main Outcomes and Measures Prevalence of DSM-5 MDD and the DSM-5 specifiers. Odds ratios (ORs), adjusted ORs (aORs), and 95% CIs indicated associations with demographic characteristics and other psychiatric disorders.

Results Of the 36 309 adult participants in NESARC-III, 12-month and lifetime prevalences of MDD were 10.4% and 20.6%, respectively. Odds of 12-month MDD were significantly lower in men (OR, 0.5; 95% CI, 0.46-0.55) and in African American (OR, 0.6; 95% CI, 0.54-0.68), Asian/Pacific Islander (OR, 0.6; 95% CI, 0.45-0.67), and Hispanic (OR, 0.7; 95% CI, 0.62-0.78) adults than in white adults and were higher in younger adults (age range, 18-29 years; OR, 3.0; 95% CI, 2.48-3.55) and those with low incomes ($19 999 or less; OR, 1.7; 95% CI, 1.49-2.04). Associations of MDD with psychiatric disorders ranged from an aOR of 2.1 (95% CI, 1.84-2.35) for specific phobia to an aOR of 5.7 (95% CI, 4.98-6.50) for generalized anxiety disorder. Associations of MDD with substance use disorders ranged from an aOR of 1.8 (95% CI, 1.63-2.01) for alcohol to an aOR of 3.0 (95% CI, 2.57-3.55) for any drug. Most lifetime MDD cases were moderate (39.7%) or severe (49.5%). Almost 70% with lifetime MDD had some type of treatment. Functioning among those with severe MDD was approximately 1 SD below the national mean. Among 12.9% of those with lifetime MDD, all episodes occurred just after the death of someone close and lasted less than 2 months. The anxious/distressed specifier characterized 74.6% of MDD cases, and the mixed-features specifier characterized 15.5%. Controlling for severity, both specifiers were associated with early onset, poor course and functioning, and suicidality.

Conclusions and Relevance Among US adults, DSM-5 MDD is highly prevalent, comorbid, and disabling. While most cases received some treatment, a substantial minority did not. Much remains to be learned about the DSM-5 MDD specifiers in the general population.

重要性 没有美国的国家数据可在患病率和相关因素DSM-5中定义-defined重度抑郁症（MDD）或MDD符DSM-5 。

目的 要当前的电流上的流行国家代表性的调查结果，相关，精神病合并症，功能，和治疗的DSM-5 MDD和初始信息上的患病率，严重程度，和治疗的DSM-5 MDD严重性，焦虑/苦恼说明符，并混合-特征说明符，以及在DSM-IV中本应被描述为丧亲的情况。

设计，设置和参加 者参加美国2012年至2013年全国酒精及相关疾病流行病学调查III（NESARC-III）的美国非住院平民（≥18岁）（n = 36 309）的代表性样本的面对面访谈）。数据收集自2012年4月至2013年6月，并于2016-2017年进行了分析。

主要成果和措施 的患病率DSM-5 MDD和DSM-5符。赔率（OR），调整后的OR（aOR）和95％CI均与人口统计学特征和其他精神疾病相关。

结果 在NESARC-III的36309名成人受试者中，MDD的12个月和终生患病率分别为10.4％和20.6％。男性（OR，0.5; 95％CI，0.46-0.55）和非裔美国人（OR，0.6; 95％CI，0.54-0.68），亚洲/太平洋岛民（OR，0.6）的12个月MDD发生率显着降低； 95％CI（0.45-0.67）和西班牙裔（OR，0.7； 95％CI，0.62-0.78）成年人高于白人，且在年轻人中（年龄范围为18-29岁； OR：3.0； 95）更高％CI，2.48-3.55）和低收入人群（$ 19 999或以下； OR，1.7； 95％CI，1.49-2.04）。MDD与精神疾病的关联性从特定恐惧症的aOR为2.1（95％CI，1.84-2.35）到广义焦虑症的aOR为5.7（95％CI，4.98-6.50）。MDD与物质使用障碍的关联范围从酒精的aOR为1.8（95％CI，1.63-2.01）到3的aOR。任何药物均为0（95％CI，2.57-3.55）。一生中大多数MDD病例为中度（39.7％）或严重（49.5％）。一生中将近70％的MDD接受过某种类型的治疗。患有严重MDD的患者的机能比全国平均水平低约1 SD。在罹患终生MDD的患者中，有12.9％的人所有发作均发生在一个亲密的人死亡后，并且持续时间不到2个月。焦虑/受苦者的特征为MDD病例的74.6％，混合特征者的特征为15.5％。控制严重程度，两个说明因素都与早期发作，不良的病程和功能以及自杀倾向有关。在罹患终生MDD的患者中，有12.9％的人所有发作均发生在一个亲密的人死亡后，并且持续时间不到2个月。焦虑/受苦者的特征为MDD病例的74.6％，而混合特征者的特征为15.5％。控制严重程度，两个说明因素都与早期发作，不良的病程和功能以及自杀倾向有关。在罹患终生MDD的患者中，有12.9％的人所有发作均发生在一个亲密的人死亡后，并且持续时间不到2个月。焦虑/受苦者的特征为MDD病例的74.6％，混合特征者的特征为15.5％。控制严重程度，两个说明因素都与早期发作，不良的病程和功能以及自杀倾向有关。

结论和相关性 在美国成年人中，DSM-5 MDD非常普遍，合并并致残。尽管大多数病例接受了某种治疗，但相当少数人没有接受治疗。关于一般人群中DSM-5 MDD规格说明，还有很多要学习的知识。