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...
| Main Authors: | , , , , , , , |
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| Format: | Article |
| Language: | English |
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BMJ Publishing Group
2023-06-01
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| Series: | BMJ Mental Health |
| Online Access: | https://ebmh.bmj.com/content/26/1/e300675.full |
| _version_ | 1827929453954596864 |
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| author | Andrea Benedetti Brooke Levis Brett Thombs Geraldine Rauch Matthias Rose Polychronis Kostoulas Dario Zocholl Felix Fischer |
| author_facet | Andrea Benedetti Brooke Levis Brett Thombs Geraldine Rauch Matthias Rose Polychronis Kostoulas Dario Zocholl Felix Fischer |
| author_sort | Andrea Benedetti |
| collection | DOAJ |
| 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. |
| first_indexed | 2024-03-13T06:22:28Z |
| format | Article |
| id | doaj.art-2d065af9f5b64509a7ab07d7b00a611e |
| institution | Directory Open Access Journal |
| issn | 2755-9734 |
| language | English |
| last_indexed | 2024-03-13T06:22:28Z |
| publishDate | 2023-06-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Mental Health |
| spelling | doaj.art-2d065af9f5b64509a7ab07d7b00a611e2023-06-09T14:30:07ZengBMJ Publishing GroupBMJ Mental Health2755-97342023-06-0126110.1136/bmjment-2023-300675Prevalence estimates of major depressive disorder in 27 European countries from the European Health Interview Survey: accounting for imperfect diagnostic accuracy of the PHQ-8Andrea Benedetti0Brooke Levis1Brett Thombs2Geraldine Rauch3Matthias Rose4Polychronis Kostoulas5Dario Zocholl6Felix Fischer7Research Institute of the McGill University Health Centre, Montreal, Quebec, CanadaLady Davis Institute for Medical Research, Jewish General Hospital, Montréal, Québec, Canadaprofessor of psychologyInstitute of Biometry and Clinical Epidemiology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, GermanyDepartment of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USAFaculty of Public Health, University of Thessaly, Volos, Greece3 Institute of Biometry and Clinical Epidemiology, Charité-Universitaetsmedizin Berlin Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany1 Department of Psychosomatic Medicine, Center for Internal Medicine and Dermatology, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, GermanyBackground 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.https://ebmh.bmj.com/content/26/1/e300675.full |
| spellingShingle | Andrea Benedetti Brooke Levis Brett Thombs Geraldine Rauch Matthias Rose Polychronis Kostoulas Dario Zocholl Felix Fischer 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 BMJ Mental Health |
| 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 |
| url | https://ebmh.bmj.com/content/26/1/e300675.full |
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