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.
Highlights
Depression symptom questionnaires are commonly used to assess symptom severity and as screening tools to identify patients who may have depression
Study selection We included articles in any language that (1) indicated in the title or abstract that they conducted a meta-analysis to determine the prevalence of depression, a depressive disorder, or depressive symptoms; (2) reported at least one pooled depression prevalence value in the abstract; and (3) included, either in the full text or in the supplementary files, a list of all meta-analyzed primary studies along with the depression classification methods used in each study
1 and 2: depression classification methods used and prevalence estimates For each included meta-analysis, we recorded whether the abstract presented pooled depression prevalence estimates based on three categories of classification methods: (1) diagnostic interviews only, (2) depression screening or rating tools only, or (3) a combination of diagnostic interviews, screening or rating tools, or other methods
Summary
Depression 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. They are commonly used for the assessment of symptom severity, regardless of diagnostic status, and as screening tools to identify people who may have depression based on scores above cutoff thresholds. When used as screening tools, they apply score-based cutoff thresholds to classify patients as positive or negative screens These thresholds are calibrated to maximize sensitivity and specificity for screening, but not for classification of disorder or, in aggregate, to estimate the prevalence of disorder based on diagnostic criteria
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