Research report The epidemiology of major depressive disorder and subthreshold depression in Izmir, Turkey: Prevalence, socioeconomic differences, impairment and help-seeking Ahmet Topuzoğlu a,n , Tolga Binbay a , Halis Ulaş b , Hayriye Elbi c , Feride Aksu Tanık d , Nesli Zağlı e , Köksal Alptekin a a Dokuz Eylul University, Department of Psychiatry, Izmir, Turkey b Dokuz Eylul University, School of Medicine, Department of Psychiatry, Izmir, Turkey c Ege University, School of Medicine, Department of Psychiatry, Izmir, Turkey d Ege University, School of Medicine, Department of Public Health, Izmir, Turkey e Ege University, Department of Psychiatry, Izmir, Turkey article info Article history: Received 22 October 2014 Received in revised form 8 April 2015 Accepted 8 April 2015 Available online 18 April 2015 Keywords: Prevalence Depression Subthreshold Community based Sociodemographic Socioeconomic abstract Background: Subclinical and clinical depression is common, widely distributed in the general population, and usually associated with role impairment and help-seeking. Reliable information at the population level is needed to estimate the disease burden of depression and associated care needs in Turkey. Method: The cross-sectional study aimed to assess the prevalence of subthreshold (SubD) and clinical major depressive disorder (MDD) in Izmir, Turkey. In the 5242 eligible households, a total of 4011 individuals were successfully interviewed, yielding a response rate of 76.5%. Prevalence estimates of MDD and SubD depression were formed by using the responses to the questions of the CIDI section E. Short Form 36 (SF-36) to assess health status and functional impairments in eight scaled scores during the last four weeks. All respondents were questioned about receiving 12-month treatment for any psychological complaints, the route of help-seeking, as well as prescribed medicines and any hospita- lization. Results: The one year prevalence estimate for CIDI/DSM IV MDD was 8.2% (95% CI, 7.4–9.1). Less educated, low income, uninsured, low SES, unemployed/disabled and housewives, slum area residents had higher one year MDD prevalence. Determined prevalence of help seeking from mental health services of SubD and MDD cases were 23.6%, 30.6% respectively. Only 24.8% of clinically depressive patients received minimally adequate treatment. Limitations: Cross sectional design. Conclusion: Higher MDD prevalence correlates with younger ages, female gender, unemployment, less education, lower monthly income, lower SES and uninsurance. Help seeking from mental health services were low. There are treatment gap and impairment in depressive group. & 2015 Elsevier B.V. All rights reserved. 1. Introduction Depressive disorders are among the main causes of disease- related disability worldwide (Murray et al., 2012; Vos et al., 2012). As well as clinical depression, subthreshold depression (SubD) is common, widely distributed in the general population, and asso- ciated with role impairment and help-seeking at all age groups (Ayuso-Mateos et al., 2010; Wesselhoeft et al., 2013). Although SubD has been defined in a wide range of forms, varying on the number of symptoms and duration required, generally it refers to conditions where number and/or duration of symptoms are below the levels of diagnostic categories (Baumeister and Morar, 2008; Karsten et al., 2010; Rodriguez et al., 2012). In recent years, numerous cross-sectional studies provided prevalence estimates of major depressive disorder (MDD) and SubD in different coun- tries with rates indicating a wide variability (Ayuso-Mateos et al., 2010; Bromet et al., 2011; Rai et al., 2013; Rodriguez et al., 2012). Despite global efforts to report prevalence estimates from different countries (Kessler et al., 2008), there is still relative lack of studies from low- and middle-income countries (Rai et al., 2013). Further- more countries and populations are not homogenous in the distribution of depressive symptomatology (Rai et al., 2013). Cultural differences, as well as contextual factors including urban Contents lists available at ScienceDirect journal homepage: www.elsevier.com/locate/jad Journal of Affective Disorders http://dx.doi.org/10.1016/j.jad.2015.04.017 0165-0327/& 2015 Elsevier B.V. All rights reserved. n Corresponding author. Tel.: þ90 232 412 51 81. E-mail addresses: drtopuzoglu@gmail.com, ahmet.topuzoglu@deu.edu.tr (A. Topuzoğlu). Journal of Affective Disorders 181 (2015) 78–86