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Predicting the onset of major depression in primary care: international validation of a risk prediction algorithm from Spain

  • J. Á. Bellón (a1), J. de Dios Luna (a2), M. King (a3), B. Moreno-Küstner (a4), I. Nazareth (a5), C. Montón-Franco (a6), M. J. GildeGómez-Barragán (a7), M. Sánchez-Celaya (a8), M. Á. Díaz-Barreiros (a9), C. Vicens (a10), J. A. Cervilla (a11), I. Švab (a12), H.-I. Maaroos (a13), M. Xavier (a14), M. I. Geerlings (a15), S. Saldivia (a16), B. Gutiérrez (a11), E. Motrico (a17), M. T. Martínez-Cañavate (a18), B. Oliván-Blázquez (a19), M. S. Sánchez-Artiaga (a20), S. March (a21), M. del Mar Muñoz-García (a22), A. Vázquez-Medrano (a7), P. Moreno-Peral (a23) and F. Torres-González (a11)...
Abstract
Background

The different incidence rates of, and risk factors for, depression in different countries argue for the need to have a specific risk algorithm for each country or a supranational risk algorithm. We aimed to develop and validate a predictD-Spain risk algorithm (PSRA) for the onset of major depression and to compare the performance of the PSRA with the predictD-Europe risk algorithm (PERA) in Spanish primary care.

Method

A prospective cohort study with evaluations at baseline, 6 and 12 months. We measured 39 known risk factors and used multi-level logistic regression and inverse probability weighting to build the PSRA. In Spain (4574), Chile (2133) and another five European countries (5184), 11 891 non-depressed adult primary care attendees formed our at-risk population. The main outcome was DSM-IV major depression (CIDI).

Results

Six variables were patient characteristics or past events (sex, age, sex×age interaction, education, physical child abuse, and lifetime depression) and six were current status [Short Form 12 (SF-12) physical score, SF-12 mental score, dissatisfaction with unpaid work, number of serious problems in very close persons, dissatisfaction with living together at home, and taking medication for stress, anxiety or depression]. The C-index of the PSRA was 0.82 [95% confidence interval (CI) 0.79–0.84]. The Integrated Discrimination Improvement (IDI) was 0.0558 [standard error (s.e.)=0.0071, Zexp=7.88, p<0.0001] mainly due to the increase in sensitivity. Both the IDI and calibration plots showed that the PSRA functioned better than the PERA in Spain.

Conclusions

The PSRA included new variables and afforded an improved performance over the PERA for predicting the onset of major depression in Spain. However, the PERA is still the best option in other European countries.

Copyright
Corresponding author
*Address for correspondence: J. Á. Bellón, M.D., Ph.D., Departamento de Medicina Preventiva, Facultad de Medicina, Universidad de Málaga, Campus de Teatinos, 29071 Málaga, Spain. (Email: JABELLON@terra.es)
References
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Alonso J, Angermeyer MC, Bernert S, Bruffaerts R, Brugha TS, Bryson H, de Girolamo G, Graaf R, Demyttenaere K, Gasquet I, Haro JM, Katz SJ, Kessler RC, Kovess V, Lépine JP, Ormel J, Polidori G, Russo LJ, Vilagut G, Almansa J, Arbabzadeh-Bouchez S, Autonell J, Bernal M, Buist-Bouwman MA, Codony M, Domingo-Salvany A, Ferrer M, Joo SS, Martínez-Alonso M, Matschinger H, Mazzi F, Morgan Z, Morosini P, Palacín C, Romera B, Taub N, Vollebergh WA; ESEMeD/MHEDEA 2000 Investigators (2004). Psychotropic drug utilization in Europe: results from the European Study of the Epidemiology of Mental Disorders (ESEMeD) project. Acta Psychiatrica Scandinavica. Supplementum 420, 5564.
Altman DG, Royston P (2000). What do we mean by validating a prognostic model? Statistics in Medicine 19, 453473.
Arnow BA (2004). Relationships between childhood maltreatment, adult health and psychiatric outcomes, and medical utilization. Journal of Clinical Psychiatry 65 (Suppl. 12), 1015.
Arroll B, Khin N, Kerse N (2003). Screening for depression in primary care with two verbally asked questions: cross sectional study. British Medical Journal 327, 11441146.
Baca E, Saiz J, Agüera L, Caballero L, Fernández-Liria A, Ramos J, Gil A, Madrigal M, Porras A (1999). Validation of the Spanish version of PRIME-MD: a procedure for diagnosing mental disorders in primary care [in Spanish]. Actas Españolas de Psiquiatría 27, 375383.
Barbor TF, de la Fuente JR, Saunders J, Grant M (1989). The Alcohol Use Disorders Identification Test: Guidelines for Use in Primary Health Care. World Health Organization: Geneva.
Bebbington P, Dunn G, Jenkins R, Lewis G, Brugha T, Farrell M, Meltzer H (2003). The influence of age and sex on the prevalence of depressive conditions: report from the National Survey of Psychiatric Morbidity. International Review of Psychiatry 15, 7483.
Bellón JA, Luna JD, Moreno B, Montón-Franco C, Gildegómez-Barragán MJ, Sánchez-Celaya M, Díaz-Barreiros MA, Vicens C, Motrico E, Martínez-Cañavate MT, Olivan-Blázquez B, Vázquez-Medrano A, Sánchez-Artiaga MS, March S, Muñoz-García MD, Moreno-Peral P, Nazareth I, King M, Torres-González F (2010). Psychosocial and sociodemographic predictors of attrition in a longitudinal study of major depression in primary care: the predictD-Spain study. Journal of Epidemiology and Community Health 64, 874884.
Bellón JA, Moreno B, Torres-González F, Montón-Franco C, GildeGómez-Barragán MJ, Sánchez-Celaya M, Díaz-Barreiros MA, Vicens C, de Dios Luna J, Cervilla JA, Gutierrez B, Martínez-Cañavate MT, Oliván-Blázquez B, Vázquez-Medrano A, Sánchez-Artiaga MS, March S, Motrico E, Ruiz-García VM, Brangier-Wainberg PR, Del Mar Muñoz-García M, Nazareth I, King M; predictD group (2008). Predicting the onset and persistence of episodes of depression in primary health care. The predictD-Spain study: methodology. BMC Public Health 8, 256.
Blaxter M (1990). Health and Lifestyles. Routledge: London.
Brugha T, Bebbington P, Tennant C, Hurry J (1985). The List of Threatening Experiences: a subset of 12 life event categories with considerable long-term contextual threat. Psychological Medicine 15, 189194.
Conroy RM, Pyorala K, Fitzgerald AP, Sans S, Menotti A, De Backer G, De Bacquer D, Ducimetière P, Jousilahti P, Keil U, Njølstad I, Oganov RG, Thomsen T, Tunstall-Pedoe H, Tverdal A, Wedel H, Whincup P, Wilhelmsen L, Graham IM; SCORE project group (2003). Estimation of ten-year risk of fatal cardiovascular disease in Europe: the SCORE project. European Heart Journal 24, 987–1003.
Cooper H, Hedges LV (1994). The Handbook of Research Synthesis. Russell Sage Foundation: New York.
Copas JB (1983). Regression, prediction and shrinkage. Journal of the Royal Statistical Society (Series B) 45, 311354.
De Girolamo G, Alonso J, Vilagut G (2006). The ESEMeD-WMH project: strengthening epidemiological research in Europe through the study of variation in prevalence estimates. Epidemiologia e Psichiatria Sociale 15, 167173.
Demyttenaere K, Bonnewyn A, Bruffaerts R, De Girolamo G, Gasquet I, Kovess V, Haro JM, Alonso J (2008). Clinical factors influencing the prescription of antidepressants and benzodiazepines: results from the European Study of the Epidemiology of Mental Disorders (ESEMeD) project. Journal of Affective Disorders 110, 8493.
Drew E, Emerek R, Mahon E (1998). Women, Work, and the Family in Europe. Routledge: London.
European Commission. Directorate General for Health and Consumer Protection (2004). The State of Mental Health in the European Union (http://ec.europa.eu/health/archive/ph_projects/2001/monitoring/fp_monitoring_2001_frep_06_en.pdf). Accessed 1 July 2010.
Fink LA, Bernstein D, Handelsman L, Foote J, Lovejoy M (1995). Initial reliability and validity of the childhood trauma interview: a new multidimensional measure of childhood interpersonal trauma. American Journal of Psychiatry 152, 13291335.
Gandek B, Ware JE, Aaronson NK, Apolone G, Bjorner JB, Brazier JE, Bullinger M, Kaasa S, Leplege A, Prieto L, Sullivan M (1998). Cross-validation of item selection and scoring for the SF-12 Health Survey in nine countries: results from the IQOLA Project. International Quality of Life Assessment. Journal of Clinical Epidemiology 51, 11711178.
Greenland S (1989). Modeling variables selection in epidemiologic analysis. American Journal of Public Health 79, 340349.
Harrell FE (2001). Regression Modelling Strategies. Springer: New York.
Hernán MA, Hernández-Díaz S, Robins JM (2004). A structural approach to selection bias. Epidemiology 15, 615625.
Janssen I, Hanssen M, Bak M, Bijl RV, de Graaf R, Vollebergh W, McKenzie K, van Os J (2003). Discrimination and delusional ideation. British Journal Psychiatry 182, 7176.
Jenkinson C, Layte R, Jenkinson D, Lawrence K, Petersen S, Paice C, Stradling J (1997). A shorter form health survey: can the SF-12 replicate results from the SF-36 in longitudinal studies? Journal of Public Health Medicine 19, 179186.
Karasek RA, Theorell T (1990). Healthy Work: Stress, Productivity, and the Reconstruction of Working Life. Basic Books: New York.
King M, Nazareth I, Levy G, Walker C, Morris R, Weich S, Bellón-Saameño JA, Moreno B, Svab I, Rotar D, Rifel J, Maaroos HI, Aluoja A, Kalda R, Neeleman J, Geerlings MI, Xavier M, de Almeida MC, Correa B, Torres-Gonzalez F (2008 a). Prevalence of common mental disorders in general practice attendees across Europe. British Journal of Psichiatry 192, 362367.
King M, Speck P, Thomas A (1995). The Royal Free interview for religious and spiritual beliefs: development and standardization. Psychological Medicine 25, 11251134.
King M, Walker C, Levy G, Bottomley C, Royston P, Weich S, Bellon-Saameno JA, Moreno B, Svab I, Rotar D, Rifel J, Maaroos HI, Aluoja A, Kalda R, Neeleman J, Geerlings MI, Xavier M, Carraca I, Goncalves-Pereira M, Vicente B, Saldivia S, Melipillan R, Torres-Gonzalez F, Nazareth I (2008 b). Development and validation of an international risk prediction algorithm for episodes of major depression in general practice attendees: the predictD study. Archives of General Psychiatry 65, 13681376.
King M, Weich S, Torres F, Svab I, Maaroos H, Neeleman J, Xavier M, Morris R, Walker C, Bellon JA, Moreno B, Rotar D, Rifel J, Aluoja A, Kalda R, Geerlings MI, Carraca I, Caldas de Almeida M, Vicente B, Saldivia S, Rioseco P, Nazareth I (2006). Prediction of depression in European general practice attendees: the PREDICT study. BMC Public Health 6, 6.
König HH, Bernert S, Angermeyer MC, Matschinger H, Martinez M, Vilagut G, Haro JM, de Girolamo G, de Graaf R, Kovess V, Alonso J; ESEMeD/MHEDEA 2000 Investigators (2009). Comparison of population health status in six European countries: results of a representative survey using the EQ-5D questionnaire. Medical Care 47, 255261.
Lee ML, Yano EM, Wang M, Simon BF, Rubenstein LV (2002). What patient population does visit-based sampling in primary care setting represent? Medical Care 40, 761770.
Little RJA, Rubin DB (2002). Statistical Analysis with Missing Data, 2nd edn. Wiley: New York.
Marrugat J, Subirana I, Comin E, Cabezas C, Vila J, Elosua R, Nam BH, Ramos R, Sala J, Solanas P, Cordón F, Gené-Badia J, D'Agostino RB; VERIFICA Investigators (2007). Validity of an adaptation of the Framingham cardiovascular risk function: the VERIFICA study. Journal of Epidemiology and Community Health 61, 4047.
Moons KGM, Royston P, Vergouwe Y, Grobbee DE, Altman DG (2009). Prognosis and prognostic research: what, why, and how? British Medical Journal 338, b375.
Pencina MJ, D'Agostino RB, D'Agostino RB, Vasan RS (2008). Evaluating the added predictive ability of a new marker: from area under the ROC curve to reclassification and beyond. Statistics in Medicine 27, 157172.
Pepe MS (2003). The Statistical Evaluation of Medical Tests for Classification and Prediction. Oxford University Press: New York.
Pérula-de Torres LA, Fernández-García JA, Arias-Vega R, Muriel-Palomino M, Marquez-Rebollo E, Ruiz-Moral R (2005). Validity of AUDIT test for detection of disorders related with alcohol consumption in women [in Spanish]. Medicina Clinica 125, 727730.
Piccinelli M, Wilkinson G (2000). Gender differences in depression. Critical review. British Journal of Psychiatry 177, 486492.
Qureshi N, Bethea J, Modell B, Brennan P, Papageorgiou A, Raeburn S, Hapgood R, Modell M (2005). Collecting genetic information in primary care: evaluating a new family history tool. Family Practice 22, 663669.
Rabe-Hesketh S, Skrondal A (2008). Multilevel and Longitudinal Modelling Using STATA, 2nd edn. STATA Press: College Station, TX.
Reher DS (1998). Family ties in Western Europe: persistent contrasts. Population and Development Review 24, 203234.
Reynolds CF, Frank E, Thase ME, Houck PR, Jennings JR, Howell JR, Lilienfeld SO, Kupfer DJ (1998). Assessment of sexual function in depressed, impotent, and healthy men: factor analysis of a Brief Sexual Function Questionnaire for men. Psychiatry Research 24, 231250.
Robins LN, Wing J, Wittchen HU, Helzer JE, Babor TF, Burke J, Farmer A, Jablenski A, Pickens R, Regier DA (1988). The Composite International Diagnostic Interview. An epidemiologic instrument suitable for use in conjunction with different diagnostic systems and in different cultures. Archives of General Psychiatry 45, 10691077.
Royston P (2005). Multiple imputation of missing values: update of ice. Stata Journal 5, 527536.
Rubio Valladolid G, Bermejo Vicedo J, Caballero Sánchez-Serrano MC, Santo-Domingo Carrasco J (1998). Validation of the alcohol use disorders identification test (AUDIT) in primary care [in Spanish]. Revista Clinica Española 198, 1114.
Rubio-Stipec M, Bravo M, Canino G (1991). The Composite International Diagnostic Interview (CIDI): an epidemiologic instrument suitable for using in conjunction with different diagnostic systems in different cultures [in Spanish]. Acta psiquiátrica y psicológica de América latina 37, 191204.
Schafer JL (1999). Multiple imputation: a primer. Statistical Methods in Medical Research 8, 315.
Sebre S, Sprugevica I, Novotni A, Bonevski D, Pakalniskiene V, Popescu D, Turchina T, Friedrich W, Lewis O (2004). Cross-cultural comparisons of child-reported emotional and physical abuse: rates, risk factors and psychosocial symptoms. Child Abuse and Neglect 28, 113127.
Snijders TAB, Bosker RJ (1999). Multilevel Analysis. An Introduction to Basic and Advanced Multilevel Modelling. Sage Publications: London.
Spitzer RL, Kroenke K, Williams JB (1999). Validation and utility of a self-report version of PRIME-MD: the PHQ primary care study. Primary Care Evaluation of Mental Disorders. Patient Health Questionnaire. Journal of the American Medical Association 282, 17371744.
Sproston K, Primatesta P (2003). Health Survey for England 2002: A Survey carried out on behalf of the Department of Health. Volume 1: The health of children and young people. The Stationery Office: London.
StataCorp (2007). Stata Statistical Software: Release 10. Stata Corporation: College Station, TX.
Tyrer P (1990). Personality disorder and social functioning. In Measuring Human Problems: A Practical Guide (ed. Peck D. F. and Shapiro C. M.), pp. 119142. Wiley & Sons: Chichester.
Weich S, Lewis G (1998). Poverty, unemployment, and common mental disorders: population based cohort study. British Medical Journal 317, 115119.
Whisman MA, Uebelacker LA (2009). Prospective associations between marital discord and depressive symptoms in middle-aged and older adults. Psychology and Aging 24, 184189.
WHO (1997). Composite International Diagnostic Interview (CIDI). Version 2.1. World Health Organization: Geneva.
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