Comparison of depression prevalence estimates in meta-analyses based on screening tools and rating scales versus diagnostic interviews: a meta-research review

Abstract

BackgroundDepression symptom questionnaires are commonly used to assess symptom severity and as screening tools to identify patients who may have depression. They are not designed to ascertain diagnostic status and, based on published sensitivity and specificity estimates, would theoretically be expected to overestimate prevalence. Meta-analyses sometimes estimate depression prevalence based on primary studies that used screening tools or rating scales rather than validated diagnostic interviews. Our objectives were to determine classification methods used in primary studies included in depression prevalence meta-analyses, if pooled prevalence differs by primary study classification methods as would be predicted, whether meta-analysis abstracts accurately describe primary study classification methods, and how meta-analyses describe prevalence estimates in abstracts.MethodsWe searched PubMed (January 2008–December 2017) for meta-analyses that reported pooled depression prevalence in the abstract. For each meta-analysis, we included up to one pooled prevalence for each of three depression classification method categories: (1) diagnostic interviews only, (2) screening or rating tools, and (3) a combination of methods.ResultsIn 69 included meta-analyses (81 prevalence estimates), eight prevalence estimates (10%) were based on diagnostic interviews, 36 (44%) on screening or rating tools, and 37 (46%) on combinations. Prevalence was 31% based on screening or rating tools, 22% for combinations, and 17% for diagnostic interviews. Among 2094 primary studies in 81 pooled prevalence estimates, 277 (13%) used validated diagnostic interviews, 1604 (77%) used screening or rating tools, and 213 (10%) used other methods (e.g., unstructured interviews, medical records). Classification methods pooled were accurately described in meta-analysis abstracts for 17 of 81 (21%) prevalence estimates. In 73 meta-analyses based on screening or rating tools or on combined methods, 52 (71%) described the prevalence as being for “depression” or “depressive disorders.” Results were similar for meta-analyses in journals with impact factor ≥ 10.ConclusionsMost meta-analyses combined estimates from studies that used screening tools or rating scales instead of diagnostic interviews, did not disclose this in abstracts, and described the prevalence as being for “depression” or “depressive disorders ” even though disorders were not assessed. Users of meta-analyses of depression prevalence should be cautious when interpreting results because reported prevalence may exceed actual prevalence.Electronic supplementary materialThe online version of this article (10.1186/s12916-019-1297-6) contains supplementary material, which is available to authorized users.

Perinatal Mental Illness in the Middle East and North Africa Region—A Systematic Overview

“…They were then considered as potential risk factors as their independence has not been ascertained. Given the measurement issues (choice of instrument, cutoff points, and lack of theoretical framework), any attempt to study association without controlling variables by individual studies is a major barrier in deriving quality evidence [ 128 , 129 ]. Studies in the region continue to study relational (spousal and others), psychological, and sociodemographic factors in detail while overlooking lifestyle, environmental and occupational factors.…”

“…The SRs with meta-analyses in our overview have not questioned the use of screening tools for determining prevalence and have not taken into consideration the sensitivity and specificity of the respective screening tools in attempts to better estimate true prevalence. Our concern is shared by other researchers [ 128 , 129 ] who have questioned the use of self-reporting screening tools for prevalence estimation. A standardized framework to group or to clearly define risk factors in the studies is also lacking.…”

Low levels of serum urate are associated with a higher prevalence of depression in older adults: a nationwide cross-sectional study in Korea

“…In addition, most symptom-screening questionnaires including the PHQ-9 were not designed to ascertain diagnostic status and would theoretically be expected to overestimate prevalence [55]. However, these tools have important applications for the assessment of symptom severity, regardless of the diagnostic status, and as screening tools to identify people who may have depression [56]. There is also an interest in the field of bipolar and related disorders, as shown in a meta-analysis reported that subjects with bipolar disorder had higher serum urate concentrations than healthy controls [57].…”

Psychological theories of depressive relapse and recurrence: A systematic review and meta-analysis of prospective studies

“…Selfreported depressive symptomatology was not used as an outcome measure, since this outcome depends on the cut-off scores that were used (and vary per article and questionnaire), and may not only reflect relapse of MDD. Furthermore, such indices provide insufficient information to accurately indicate remission or recovery of MDD (Levis et al, 2019;Stuart et al, 2014), while our aim was to investigate the psychological theories in people with established diagnoses according to the current classification systems. This outcome measure could be reported as time to relapse, or as an occurrence (relapse yes/no).…”