FIGURE 5.4 Age of onset of DIS/DSM-III Major Depressive Disorder. Population estimates are from 148 new cases (with 20th and 50th percentiles marked). Source: NIMH Epidemiologic Catchment Area Study, Four Sites, 1978 to 1983.

suicide than as a result of homicide (National Center for Health Statistics, 1993). Although the definitions of depression have varied, many studies link depression and suicide. More than half of suicides occur in adults suffering from depression (Barraclough, Bunch, Nelson, and Sainsbury, 1974). The lifetime risk of suicide in persons suffering from depression is 15 percent (IOM, 1990a). The risk of suicide among depressed persons of all ages is 30 times higher than in the general population (Guze and Robins, 1970). Twenty percent of all suicides occur in persons over 65 (Vital Statistics of the United States, 1975). Rates are strikingly higher for elderly white men than for other groups.

Both pharmacological and psychological treatment methods for depression have shown considerable success (Klerman, 1988; Weissman, 1988). There is also evidence that high-quality maintenance therapy substantially increases the likelihood of a good outcome for depressive disorders (Frank, Kupfer, Perel, Cornes, Jarrett, Mallinger et al., 1990). Thus clinical depression is unusual among the major mental illnesses in having good treatments available. It is therefore particularly important for clinicians to recognize the signs and symptoms of depressive disorders as well as note the existence of risk factors in susceptible patients' lives, because much suffering can be eliminated by the effective treatments available. Depressive disorders, especially if untreated, have profound effects on families, in particular on the children and spouses of those who are afflicted (Beardslee and Wheelock, in press; Keitner and Miller, 1991; Downey and Coyne, 1990).

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