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Prevalence estimates of major depressive disorder in 27 European countries from the European Health Interview Survey: accounting for imperfect diagnostic accuracy of the PHQ-8
BACKGROUND: Cut-offs on self-report depression screening tools are designed to identify many more people than those who meet criteria for major depressive disorder. In a recent analysis of the European Health Interview Survey (EHIS), the percentage of participants with Patient Health Questionnaire-8...
Autores principales: | , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BMJ Publishing Group
2023
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10083787/ https://www.ncbi.nlm.nih.gov/pubmed/37024144 http://dx.doi.org/10.1136/bmjment-2023-300675 |
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author | Fischer, Felix Zocholl, Dario Rauch, Geraldine Levis, Brooke Benedetti, Andrea Thombs, Brett Rose, Matthias Kostoulas, Polychronis |
author_facet | Fischer, Felix Zocholl, Dario Rauch, Geraldine Levis, Brooke Benedetti, Andrea Thombs, Brett Rose, Matthias Kostoulas, Polychronis |
author_sort | Fischer, Felix |
collection | PubMed |
description | BACKGROUND: Cut-offs on self-report depression screening tools are designed to identify many more people than those who meet criteria for major depressive disorder. In a recent analysis of the European Health Interview Survey (EHIS), the percentage of participants with Patient Health Questionnaire-8 (PHQ-8) scores ≥10 was reported as major depression prevalence. OBJECTIVE: We used a Bayesian framework to re-analyse EHIS PHQ-8 data, accounting for the imperfect diagnostic accuracy of the PHQ-8. METHODS: The EHIS is a cross-sectional, population-based survey in 27 countries across Europe with 258 888 participants from the general population. We incorporated evidence from a comprehensive individual participant data meta-analysis on the accuracy of the PHQ-8 cut-off of ≥10. We evaluated the joint posterior distribution to estimate the major depression prevalence, prevalence differences between countries and compared with previous EHIS results. FINDINGS: Overall, major depression prevalence was 2.1% (95% credible interval (CrI) 1.0% to 3.8%). Mean posterior prevalence estimates ranged from 0.6% (0.0% to 1.9%) in the Czech Republic to 4.2% (0.2% to 11.3%) in Iceland. Accounting for the imperfect diagnostic accuracy resulted in insufficient power to establish prevalence differences. 76.4% (38.0% to 96.0%) of observed positive tests were estimated to be false positives. Prevalence was lower than the 6.4% (95% CI 6.2% to 6.5%) estimated previously. CONCLUSIONS: Prevalence estimation needs to account for imperfect diagnostic accuracy. CLINICAL IMPLICATIONS: Major depression prevalence in European countries is likely lower than previously reported on the basis of the EHIS survey. |
format | Online Article Text |
id | pubmed-10083787 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2023 |
publisher | BMJ Publishing Group |
record_format | MEDLINE/PubMed |
spelling | pubmed-100837872023-08-21 Prevalence estimates of major depressive disorder in 27 European countries from the European Health Interview Survey: accounting for imperfect diagnostic accuracy of the PHQ-8 Fischer, Felix Zocholl, Dario Rauch, Geraldine Levis, Brooke Benedetti, Andrea Thombs, Brett Rose, Matthias Kostoulas, Polychronis BMJ Ment Health Original Research BACKGROUND: Cut-offs on self-report depression screening tools are designed to identify many more people than those who meet criteria for major depressive disorder. In a recent analysis of the European Health Interview Survey (EHIS), the percentage of participants with Patient Health Questionnaire-8 (PHQ-8) scores ≥10 was reported as major depression prevalence. OBJECTIVE: We used a Bayesian framework to re-analyse EHIS PHQ-8 data, accounting for the imperfect diagnostic accuracy of the PHQ-8. METHODS: The EHIS is a cross-sectional, population-based survey in 27 countries across Europe with 258 888 participants from the general population. We incorporated evidence from a comprehensive individual participant data meta-analysis on the accuracy of the PHQ-8 cut-off of ≥10. We evaluated the joint posterior distribution to estimate the major depression prevalence, prevalence differences between countries and compared with previous EHIS results. FINDINGS: Overall, major depression prevalence was 2.1% (95% credible interval (CrI) 1.0% to 3.8%). Mean posterior prevalence estimates ranged from 0.6% (0.0% to 1.9%) in the Czech Republic to 4.2% (0.2% to 11.3%) in Iceland. Accounting for the imperfect diagnostic accuracy resulted in insufficient power to establish prevalence differences. 76.4% (38.0% to 96.0%) of observed positive tests were estimated to be false positives. Prevalence was lower than the 6.4% (95% CI 6.2% to 6.5%) estimated previously. CONCLUSIONS: Prevalence estimation needs to account for imperfect diagnostic accuracy. CLINICAL IMPLICATIONS: Major depression prevalence in European countries is likely lower than previously reported on the basis of the EHIS survey. BMJ Publishing Group 2023-04-05 /pmc/articles/PMC10083787/ /pubmed/37024144 http://dx.doi.org/10.1136/bmjment-2023-300675 Text en © Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. Published by BMJ. https://creativecommons.org/licenses/by-nc/4.0/This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/ (https://creativecommons.org/licenses/by-nc/4.0/) . |
spellingShingle | Original Research Fischer, Felix Zocholl, Dario Rauch, Geraldine Levis, Brooke Benedetti, Andrea Thombs, Brett Rose, Matthias Kostoulas, Polychronis Prevalence estimates of major depressive disorder in 27 European countries from the European Health Interview Survey: accounting for imperfect diagnostic accuracy of the PHQ-8 |
title | Prevalence estimates of major depressive disorder in 27 European countries from the European Health Interview Survey: accounting for imperfect diagnostic accuracy of the PHQ-8 |
title_full | Prevalence estimates of major depressive disorder in 27 European countries from the European Health Interview Survey: accounting for imperfect diagnostic accuracy of the PHQ-8 |
title_fullStr | Prevalence estimates of major depressive disorder in 27 European countries from the European Health Interview Survey: accounting for imperfect diagnostic accuracy of the PHQ-8 |
title_full_unstemmed | Prevalence estimates of major depressive disorder in 27 European countries from the European Health Interview Survey: accounting for imperfect diagnostic accuracy of the PHQ-8 |
title_short | Prevalence estimates of major depressive disorder in 27 European countries from the European Health Interview Survey: accounting for imperfect diagnostic accuracy of the PHQ-8 |
title_sort | prevalence estimates of major depressive disorder in 27 european countries from the european health interview survey: accounting for imperfect diagnostic accuracy of the phq-8 |
topic | Original Research |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10083787/ https://www.ncbi.nlm.nih.gov/pubmed/37024144 http://dx.doi.org/10.1136/bmjment-2023-300675 |
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