Crossnational Epidemiology And Major Depression

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The analyses of cross-national epidemiological data, collected using high-quality modern diagnostic and epidemiological sampling methods, does provide one method of testing the hypothesis that a lower omega-3 fatty acid status is related to higher prevalence rates of affective disorders, psychotic disorders, or aggressive behaviors. Economic data describing seafood consumption has been useful in these cross-national studies. Although economic data on the production and consumption of seafood cannot accurately be used to quantify dietary intake for an individual, these data can be used to describe trends for the populations of entire countries and thus provide a basis for comparing consumption across countries (World Health Organization, 1996). The financial incentive to produce accurate data also adds some confidence to the accuracy of consumption estimates derived from economic data. When compared cross-nationally, greater amounts of seafood consumption were robustly correlated (r=-0.85, p < 0.0005) with lower lifetime prevalence rates of major depression (Hibbeln, 1998) (see Table 1). The prevalence rates of major depression varied nearly 50-fold across countries as assessed by studies using methods similar to the Epidemiological Catchment Area study, a gold standard of studies in psychiatric epidemiology. The primary data sets of the studies were combined for cross-national analyses and weighted for age, sex, and other demographic differences (Weissman et al., 1996). These data appear to be robust after consideration of potential differences in cultural biases in diagnosis because a structured interview with standardized diagnostic criteria was validated in each country prior to the community sampling. Comparative relationships to prevalence rates of postpartum depression, bipolar affective disorder, homicide mortality, suicide mortality, and schizophrenia will be presented later in this chapter, with the discussion of each of these issues. Although cross-national studies do not provide direct evidence of causal relationships, they do offer a perspective on the potential magnitude of these relationships.

Table 1

Seafood Consumption and Annual Prevalence Rates of Major Depression by Country

Table 1

Seafood Consumption and Annual Prevalence Rates of Major Depression by Country


Major Depression (annual rate/100 persons)

Seafood consumption (lbs/person/yr)


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