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.

中文翻译：

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欧洲健康访谈调查对 27 个欧洲国家重度抑郁症患病率的估计：考虑到 PHQ-8 诊断准确性的不完善

背景 自我报告抑郁症筛查工具的截止点旨在识别比符合重度抑郁症标准的人更多的人。在欧洲健康访谈调查 (EHIS) 最近的一项分析中，患者健康问卷 8 (PHQ-8) 分数≥10 的参与者百分比被报告为重度抑郁症患病率。目的 我们使用贝叶斯框架重新分析 EHIS PHQ-8 数据，解决 PHQ-8 诊断准确性不完善的问题。方法 EHIS 是一项在欧洲 27 个国家进行的基于人口的横断面调查，共有 258 888 名普通民众参与。我们整合了来自综合个体参与者数据荟萃分析的证据，证明 PHQ-8 截止值≥10 的准确性。我们评估了联合后验分布，以估计重度抑郁症的患病率、国家之间的患病率差异，并与之前的 EHIS 结果进行比较。结果 总体而言，重度抑郁症患病率为 2.1%（95% 可信区间 (CrI) 为 1.0% 至 3.8%）。平均后验患病率估计范围从捷克共和国的 0.6%（0.0% 至 1.9%）到冰岛的 4.2%（0.2% 至 11.3%）。考虑到不完善的诊断准确性导致没有足够的力量来确定患病率差异。观察到的阳性检测中 76.4%（38.0% 至 96.0%）估计为假阳性。患病率低于之前估计的 6.4%（95% CI 6.2% 至 6.5%）。结论 患病率估计需要考虑不完善的诊断准确性。临床意义 欧洲国家的重度抑郁症患病率可能低于之前根据 EHIS 调查报告的情况。