Lady Davis Institute for Medical Research, Jewish General Hospital, 4333 Cote Ste Catherine Road, Montreal, Quebec, Canada.
Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada.
BMC Med. 2019 Mar 21;17(1):65. doi: 10.1186/s12916-019-1297-6.
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. 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.
We 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.
In 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.
Most 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.
抑郁症状问卷常用于评估症状严重程度，并作为筛查工具来识别可能患有抑郁症的患者。它们不是为了确定诊断状态而设计的，根据已发表的敏感性和特异性估计，理论上它们会高估患病率。荟萃分析有时会根据使用筛查工具或评分量表而不是经过验证的诊断访谈的主要研究来估计抑郁患病率。我们的目标是确定纳入抑郁患病率荟萃分析的主要研究中使用的分类方法，如果汇总的患病率与预期的主要研究分类方法不同，以及荟萃分析摘要是否准确描述主要研究分类方法，以及荟萃分析如何在摘要中描述患病率估计值。
我们在 PubMed 上搜索了 2008 年 1 月至 2017 年 12 月的荟萃分析，以获取摘要中报告的汇总抑郁患病率。对于每项荟萃分析，我们为以下三个抑郁分类方法类别中的每个类别最多包含一个汇总患病率：（1）仅诊断访谈，（2）筛查或评分工具，以及（3）方法组合。
在纳入的 69 项荟萃分析（81 个患病率估计值）中，有 8 个（10%）基于诊断访谈，36 个（44%）基于筛查或评分工具，37 个（46%）基于方法组合。基于筛查或评分工具的患病率为 31%，基于组合的患病率为 22%，基于诊断访谈的患病率为 17%。在 81 个汇总患病率估计值中的 2094 项主要研究中，有 277 项（13%）使用了经过验证的诊断访谈，1604 项（77%）使用了筛查或评分工具，213 项（10%）使用了其他方法（例如，非结构化访谈，医疗记录）。荟萃分析摘要中准确描述了 81 个患病率估计值中的 17 个（21%）分类方法。在基于筛查或评分工具或组合方法的 73 项荟萃分析中，有 52 项（71%）将患病率描述为“抑郁”或“抑郁障碍”。在影响因子≥10 的期刊上发表的荟萃分析中，结果相似。
大多数荟萃分析综合了使用筛查工具或评分量表而不是诊断访谈的研究的估计值，但在摘要中并未披露这一点，并且将患病率描述为“抑郁”或“抑郁障碍”，尽管未评估障碍。使用抑郁患病率荟萃分析的用户在解释结果时应谨慎，因为报告的患病率可能超过实际患病率。
