The Zurich study

III. Diagnosis of depression
  • J. Angst
  • A. Dobler-Mikola


A 23- to 24-year-old age group representative of the general population of the Canton of Zurich, was used to detect depression. The classifications obtained by means of the Feighner, RDC and DSM-111 criteria are compared with our own concept, which differs in some aspects. A minimum of 2 weeks of depression is labeled as EDE (extensive depressive episode). Instead of the presence of a minimum number of depressive symptoms, social impairment at work is first examined as a case-defining criterion (EDE[WORK]); in a second step, a diagnostic threshold of three, and five, depressive symptoms for males and females respectively is adopted (EDE[SYM]). The consequences are presented relating to prevalence, incidence, sex distribution, overlap with other diagnostic concepts, severity, bipolarity and family history. An unequal sex distribution in depression is shown to be an artifact of definition.

Preference should go to a case-definition that could be specifically adapted to a given problem. On the whole, the DSM-III and EDE(WORK) criteria appear to be too broad. We will henceforth prefer the RDC and EDE(SYM) criteria, which both, however, necessitate further methodological and empirical study.

Key words

Epidemiology Prevalence Incidence Depression Sex ratio Feighner, RDC and DSM-III diagnostics EDE (extensive depressive episodes) 


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  1. American Psychiatric Association (1980) Diagnostic and statistical manual of mental disorders (DSM-III), 3rd edn. American Psychiatric Association, Washington, DCGoogle Scholar
  2. Angst J, Dobler-Mikola A (1984a) The definition of depression. In: Garattini S, Tognoni G (eds) Biological Markers in Mental Disorders. Psychiatr Res (in press)Google Scholar
  3. Angst J, Dobler-Mikola A (1984b) The Zurich Study—A prospective study of depressive, neurotic and psychosomatic syndromes. II: The continuum from normal to pathological depressive mood swings. Eur Arch Psychiatr Neurol Sci 234:21–29Google Scholar
  4. Angst J, Dobler-Mikola A, Binder J (1984c) The Zurich Study-A prospective study of depressive, neurotic and psychosomatic syndromes. I: Problem, methodology. Eur Arch Psychiatr Neurol Sci 234:13–20Google Scholar
  5. Angst J, Dobler-Mikola A, Binder J (1983) Zur Diagnostik der Depression-epidemiologische und genetische Aspekte. In: Pöldinger W (ed) Aktuelle Aspekte der Depressionsbehandlung. Grundlagen-Diagnostik-Th rapie. Ergebnisse des Int. Vivalan-Symposiums CH-Rigi 1982. Huber, Bern Stuttgart Wien, pp 68–81 + 91–93Google Scholar
  6. Binder J, Angst J (1981) Soziale Konsequenzen psychischer Störungen in der Bevölkerung. Eine Feldstudie an jungen Erwachsenen. Arch Psychiat Nervenkr 229:355–370Google Scholar
  7. Clayton PJ (1981) The epidemiology of bipolar affective disorder. Comprehens. Psychiat 22:31–43Google Scholar
  8. Copeland J (1981) What is a ‘case’? A case for what? In: Wing JK, Bebbington P, Robins LN (eds) What is a case? The problem of definition in psychiatric community surveys. Grant McIntyre, London, pp 9–11Google Scholar
  9. Derogatis LR (1977) SCL-90. Administration, scoring and procedures manual-I for the R (revised) version and other instruments of the psychopathology rating scale series. Johns Hopkins University School of Medicine, ChicagoGoogle Scholar
  10. Feighner JP, Robins E, Guze SB, Woodruff RA, Winokur G, Manoz R (1972) Diagnostic criteria for use in psychiatric research. Arch Gen Psychiatr 26:57–63Google Scholar
  11. Hagnell O, Lanke J, Rorsman B, Öjesjö L (1982) Are we entering an age of melancholy? Depressive illnesses in a prospective epidemiological study over 25 years: the Lundby Study, Sweden. Psychol Med 12:279–289Google Scholar
  12. Pearlin LI, Schooler C (1978) The structure of coping. J Hlth Soc Behav 19:2–21Google Scholar
  13. Spitzer RL, Endicott J, Robins E (1978) Research diagnostic criteria. Arch Gen Psychiatry 35:773–782Google Scholar
  14. Wing JK, Cooper JE, Sartorius N (1974) Measurement and classification of psychiatric symptoms: An instruction manual for the PSE and Catego program. Cambridge University Press, LondonGoogle Scholar

Copyright information

© Springer-Verlag 1984

Authors and Affiliations

  • J. Angst
    • 1
  • A. Dobler-Mikola
    • 1
  1. 1.Zurich, Research DepartmentPsychiatric Universtiy HospitalZurichSwitzerland

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