The literature review demonstrated the extent and consequences of Major Depressive Disorder in the United States. States that Basic epidemiologic information regarding the prevalence of Major Depressive Disorder was examined as well as prevalence in primary care settings, where Major Depressive Disorder is often treated. Major depression was appraised in relation to comorbidity, misdiagnosis, under-diagnosis, and under-treatment.

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Consequences of this illness, including reduced quality of life, significant economic impact, and the worst possible outcome, suicide, were detailed. The overall effectiveness and cost-effectiveness of treatment was highlighted. Efficacious treatment for Major Depression for this disorder was reviewed, most specifically, pharmacologic treatment, and two psychotherapeutic interventions Interpersonal Therapy and Cognitive-Behavioral therapy.

Efficacy of CBT, in particular, was examined in relation to its theoretical constructs and mechanisms. The integral nature of CBT homework to its efficacy was reviewed as well as the critical need to appraise barriers to the successful completion. The literature review demonstrated the deficiency in CBT, both clinically and in the conduct of research, to validly measure perceived barriers to successful homework completion. Major Depression, considered a common disorder, has been reported to have a lifetime prevalence ranging from 5 to 17.1% (National Institute of Mental Health, 2000; Regier et el, 1988; Regier et al., 1993; Kessler et al., 1994; Blazer et al., 1994).

The National Institute of Mental Health (2000) documents this disorder as affecting 9.9 million American adults. Epidemiological estimates for Major Depressive Disorder have changed over time in relation to the nosology of the disorder itself. It was not until the introduction of the third Diagnostic and Statistical Manual for Mental Disorders, by the American Psychiatric Association on Nomenclature and Statistics, those explicit diagnostic criteria, a multi-axial system, and a descriptive approach that attempted to be neutral with respect to theories and etiology, were made available for the diagnosis of depression and other psychiatric disorders.

The revised third and fourth volumes of the Diagnostic and Statistic Manual identified inconsistencies and used empirical evidence to further specify diagnoses (American Psychiatric Association, 1994). Thus, more recent epidemiologic research, the Epidemiologic Catchment Area study of the early 1980’s and the National Comorbidity Survey of the early 1990’s, relied on the clustering of signs and symptoms rather than simple presentation of signs and symptoms.