Validation of case definitions of depression derived from administrative data against the CIDI-SF as reference standard: results from the PROspective Qu\xe9bec (PROQ) study

Ana Paula Bruno Pena-Gralle,Sophie Lauzier,Chantal Brisson,Alain Lesage,Denis Talbot,Karine Aubé,Xavier Trudel,Alain Milot

doi:10.1186/s12888-021-03501-x

Abstract

BackgroundAdministrative data have several advantages over questionnaire and interview data to identify cases of depression: they are usually inexpensive, available for a long period of time and are less subject to recall bias and differential classification errors. However, the validity of administrative data in the correct identification of depression has not yet been studied in general populations. The present study aimed to 1) evaluate the sensitivity and specificity of administrative cases of depression using the validated Composite International Diagnostic Interview – Short Form (CIDI-SF) as reference standard and 2) compare the known-groups validity between administrative and CIDI-SF cases of depression.MethodsThe 5487 participants seen at the last wave (2015–2018) of the PROQ cohort had CIDI-SF questionnaire data linked to hospitalization and medical reimbursement data provided by the provincial universal healthcare provider and coded using the International Classification of Disease. We analyzed the sensitivity and specificity of several case definitions of depression from this administrative data. Their association with known predictors of depression was estimated using robust Poisson regression models.ResultsAdministrative cases of depression showed high specificity (≥ 96%), low sensitivity (19–32%), and rather low agreement (Cohen’s kappa of 0.21–0.25) compared with the CIDI-SF. These results were consistent over strata of sex, age and education level and with varying case definitions. In known-groups analysis, the administrative cases of depression were comparable to that of CIDI-SF cases (RR for sex: 1.80 vs 2.03 respectively, age: 1.53 vs 1.40, education: 1.52 vs 1.28, psychological distress: 2.21 vs 2.65).ConclusionThe results obtained in this large sample of a general population suggest that the dimensions of depression captured by administrative data and by the CIDI-SF are partially distinct. However, their known-groups validity in relation to risk factors for depression was similar to that of CIDI-SF cases. We suggest that neither of these data sources is superior to the other in the context of large epidemiological studies aiming to identify and quantify risk factors for depression.

Highlights

Depression is the most common mental disorder worldwide: according to estimates of the World Health Organization (WHO), the 12-month prevalence of depression is 4.4% [1] while the lifetime prevalence is 10% [2,3,4]
The results obtained in this large sample of a general population suggest that the dimensions of depression captured by administrative data and by the CIDI-SF are partially distinct
The sample was restricted to participants who responded to the CIDI-SF instrument at the last data collection wave and who consented to having their data linked with the administrative data provided by the provincial universal healthcare provider, the Régie de l’Assurance Maladie du Québec (RAMQ; n = 5487, 66% of those eligible to this last wave)

Summary

Introduction

Depression is the most common mental disorder worldwide: according to estimates of the World Health Organization (WHO), the 12-month prevalence of depression is 4.4% [1] while the lifetime prevalence is 10% [2,3,4]. Cases of depression can be estimated from studies that employed clinical interviews or questionnaires, or from administrative data such as physician billing or hospital discharge data [9]. The latter have several advantages over questionnaires: they are usually inexpensive, available for a long period of time and are less subject to recall bias and differential misclassification. Administrative data have several advantages over questionnaire and interview data to identify cases of depression: they are usually inexpensive, available for a long period of time and are less subject to recall bias and differential classification errors. The present study aimed to 1) evaluate the sensitivity and specificity of administrative cases of depression using the validated Composite International Diagnostic Interview – Short Form (CIDI-SF) as reference standard and 2) compare the known-groups validity between administrative and CIDI-SF cases of depression

Methods

Results

Discussion

Conclusion