Major depressive disorder affected approximately 216 million people (3% of the world's population) in 2015.[6] The percentage of people who are affected at one point in their life varies from 7% in Japan to 21% in France.[4] Lifetime rates are higher in the developed world (15%) compared to the developing world (11%).[4] It causes the second-most years lived with disability, after lower back pain.[18] The most common time of onset is in a person's 20s and 30s.[3][4] Females are affected about twice as often as males.[3][4] The American Psychiatric Association added "major depressive disorder" to the Diagnostic and Statistical Manual of Mental Disorders (DSM-III) in 1980.[19] It was a split of the previous depressive neurosis in the DSM-II, which also encompassed the conditions now known as dysthymia and adjustment disorder with depressed mood.[19] Those currently or previously affected may be stigmatized.[20]