Weye Nanna, McGrath John J, Lasgaard Mathias, Momen Natalie C, Knudsen Ann Kristin, Musliner Katherine, Plana-Ripoll Oleguer
Department of Clinical Epidemiology, Aarhus University and Aarhus University Hospital, Aarhus, Denmark.
Department of Disease Burden, Norwegian Institute of Public Health, Bergen, Norway.
Acta Psychiatr Scand. 2023 Jun;147(6):581-592. doi: 10.1111/acps.13555. Epub 2023 Apr 14.
Register-based studies of major depressive disorder (MDD) do not capture all prevalent cases, as untreated cases and diagnoses made by general practitioners are not recorded in the registers. We examined the prevalence and agreement of survey- and register-based measures of depression, and explored sociodemographic and health-related factors that may have influenced this agreement.
All 32,407 participants in the 2017 Central Denmark Region How are you? survey were linked to hospital and prescription records. A checklist for depressive symptoms within the last 14 days (Major Depression Inventory; MDI) from the survey was compared with register-based assessment of hospital-diagnosed MDD and/or prescriptions for antidepressants. We estimated agreement between survey-based and register-based measures for depression and used logistic regression models to explore selected associated factors.
In total, 5.9% of How are you? survey participants screened positive for current depression on the MDI. Of these, 51.3% (95% confidence interval (CI): 49.0-53.6) filled a prescription for an antidepressant medication during the 10 years prior or 2 years following the administration of the survey, and 14.5% (95% CI: 12.9-16.2) were treated for MDD in a psychiatric hospital-based setting. When using a higher threshold of the MDI indicating more severe current depression, 22.8% (95% CI: 19.6-26.1) of those who screened positive also received an MDD diagnosis and 63.4% (95% CI: 59.7-67.2) were prescribed antidepressants during this 12-year period. Among those with current depression, female sex, older age, chronic diseases, hospital-treated self-harm, and being permanently outside the workforce were associated with having a register-based MDD diagnosis or antidepressant prescription. Among those with a register-based depression record, female sex, younger age, hospital-treated self-harm, stress, and severe loneliness were associated with current depression.
We found that as few as 15% of individuals with current depression in the general Danish population were captured by the psychiatric hospital register, while 51% of these individuals were identifiable in the prescription register. These findings demonstrate that register-based measures significantly underestimate the true prevalence of depression by identifying only the cases that are most severe.
基于登记系统的重度抑郁症（MDD）研究无法涵盖所有患病病例，因为未治疗病例以及全科医生做出的诊断未记录在登记系统中。我们研究了基于调查和基于登记系统的抑郁症测量方法的患病率及一致性，并探讨了可能影响这种一致性的社会人口学和健康相关因素。
2017年丹麦中部地区“你好吗？”调查中的所有32407名参与者与医院和处方记录进行了关联。将调查中过去14天内抑郁症状清单（重度抑郁量表；MDI）与基于登记系统的医院诊断MDD和/或抗抑郁药处方评估进行比较。我们估计了基于调查和基于登记系统的抑郁症测量方法之间的一致性，并使用逻辑回归模型探讨选定的相关因素。
总体而言，“你好吗？”调查参与者中5.9%在MDI上筛查出当前抑郁呈阳性。其中，51.3%（95%置信区间（CI）：49.0 - 53.6）在调查前10年或调查后2年内开具了抗抑郁药物处方，14.5%（95%CI：12.9 - 16.2）在精神病医院环境中接受了MDD治疗。当使用更高的MDI阈值表示当前抑郁更严重时，筛查呈阳性的人中22.8%（95%CI：19.6 - 26.1）也被诊断为MDD，并且在这12年期间63.4%（95%CI：59.7 - 67.2）被开具了抗抑郁药。在当前患有抑郁症的人群中，女性、年龄较大、患有慢性病、因自伤接受过医院治疗以及永久失业与基于登记系统的MDD诊断或抗抑郁药处方相关。在有基于登记系统的抑郁记录的人群中，女性、年龄较小、因自伤接受过医院治疗、压力和严重孤独与当前抑郁相关。
我们发现，丹麦普通人群中当前患有抑郁症的个体，只有15%被精神病医院登记系统记录，而这些个体中有51%可在处方登记系统中识别。这些发现表明，基于登记系统的测量方法仅识别出最严重的病例，从而显著低估了抑郁症的真实患病率。
