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

• Main Authors: Fischer, Felix, Zocholl, Dario, Rauch, Geraldine, Levis, Brooke, Benedetti, Andrea, Thombs, Brett, Rose, Matthias S. F., Kostoulas, Polychronis
• Other Authors: Population and Quantitative Health Sciences
• Format: Article in Journal/Newspaper
• Language: English
• Published: 2024
• Subjects: adult psychiatry; depression & mood disorders; Iceland
• Online Access: https://doi.org/10.1136/bmjment-2023-300675; https://hdl.handle.net/20.500.14038/53667

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.