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.
- adult psychiatry
- depression & mood disorders
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Contributors FF and PK conceived the study. FF and DZ performed data analysis. FF, DZ, GR, BL, AB, BT, MR and PK contributed to study design and interpretation. FF drafted the manuscript. DZ, GR, BL, AB, BT, MR and PK provided critical reviews and approved the final manuscript. FF as the guarantor of the study accepts full responsibility for the work and the conduct of the study, had access to the data, and controlled the decision to publish.
Funding BL was supported by a Fonds de recherche du Québec—Santé (FRQS) Postdoctoral Training Fellowship, AB by a FRQS researcher salary award and BT by a Tier 1 Canada Research Chair, all outside of the present work.
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.
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