Hostname: page-component-7c8c6479df-7qhmt Total loading time: 0 Render date: 2024-03-28T18:11:32.926Z Has data issue: false hasContentIssue false

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

Published online by Cambridge University Press:  05 April 2011

J. Á. Bellón*
Affiliation:
Centro de Salud El Palo, Unidad de Investigación del Distrito de Atención Primaria de Málaga (redIAPP, grupo SAMSERAP); Departamento de Medicina Preventiva, Universidad de Málaga, Spain;
J. de Dios Luna
Affiliation:
Departamento de Bioestadística (redIAPP, grupo SAMSERAP), Universidad de Granada, Spain;
M. King
Affiliation:
Department of Mental Health Sciences, University College London, UK;
B. Moreno-Küstner
Affiliation:
Fundación IMABIS; Unidad de Investigación del Distrito de Atención Primaria de Málaga (redIAPP, grupo SAMSERAP); Departamento de Personalidad, Evaluación y Tratamiento Psicológico, Universidad de Málaga, Spain;
I. Nazareth
Affiliation:
Department of Primary care and Population Health, University College London and Medical Research Council General Practice Research Framework, UK;
C. Montón-Franco
Affiliation:
Centro de Salud Casablanca. (redIAPP, grupo Aragón); Departamento de Medicina y Psiquiatría, Universidad de Zaragoza, Spain;
M. J. GildeGómez-Barragán
Affiliation:
Unidad Docente de Medicina Familiar y Comunitaria de La Rioja, Servicio Riojano de la Salud, Logroño, La Rioja, Spain;
M. Sánchez-Celaya
Affiliation:
Unidad Docente de Medicina Familiar y Comunitaria, Área I de Atención Primaria, Madrid, Coordinadora de Investigación de la Sociedad Española de Medicina Familiar y Comunitaria, Spain;
M. Á. Díaz-Barreiros
Affiliation:
Centro de Salud Vecindario, Gerencia de Atención Primaria de Gran Canaria, Servicio Canario de Salud, Las Palmas, Spain;
C. Vicens
Affiliation:
Centro de Salud son Serra-La Vileta, Unidad Docente de Medicina Familiar y Comunitaria de Mallorca, Instituto Balear de la Salud (redIAPP, grupo Baleares), Palma de Mallorca, Illes Balears, Spain;
J. A. Cervilla
Affiliation:
CIBERSAM, Departamento de Psiquiatría y Medicina legal, Universidad de Granada, Spain;
I. Švab
Affiliation:
Department of Family Medicine, University of Ljubljana, Slovenia;
H.-I. Maaroos
Affiliation:
Faculty of Medicine, University of Tartu, Estonia;
M. Xavier
Affiliation:
Faculdade Ciências Médicas, University of Lisbon, Portugal;
M. I. Geerlings
Affiliation:
University Medical Centre, Utrecht, The Netherlands;
S. Saldivia
Affiliation:
Departamento de Psiquiatría y Salud Mental, Universidad de Concepción, Chile;
B. Gutiérrez
Affiliation:
CIBERSAM, Departamento de Psiquiatría y Medicina legal, Universidad de Granada, Spain;
E. Motrico
Affiliation:
Fundación IMABIS, Unidad de Investigación del Distrito de Atención Primaria de Málaga (redIAPP, grupo SAMSERAP); Departamento de Psicología Social, Universidad de Málaga, Spain;
M. T. Martínez-Cañavate
Affiliation:
Fundación IAVANTE, Granada, Spain;
B. Oliván-Blázquez
Affiliation:
Unidad de Investigación de Atención Primaria (redIAPP, grupo Aragón); Instituto Aragonés de Ciencias de la Salud, Zaragoza, Spain;
M. S. Sánchez-Artiaga
Affiliation:
Centro de Salud Condes de Barcelona-Boadilla, Área 6 de Atención Primaria, Madrid, Spain;
S. March
Affiliation:
Unidad de Investigación de Atención Primaria de Baleares (redIAPP, grupo Baleares), Mallorca, Spain;
M. del Mar Muñoz-García
Affiliation:
Departamento de Psiquiatría y Medicina legal, Universidad de Granada, Spain;
A. Vázquez-Medrano
Affiliation:
Unidad Docente de Medicina Familiar y Comunitaria de La Rioja, Servicio Riojano de la Salud, Logroño, La Rioja, Spain;
P. Moreno-Peral
Affiliation:
Fundación IMABIS, Unidad de Investigación del Distrito de Atención Primaria de Málaga (redIAPP, grupo SAMSERAP), Málaga, Spain
F. Torres-González
Affiliation:
CIBERSAM, Departamento de Psiquiatría y Medicina legal, Universidad de Granada, Spain;
*
*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)

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.

Type
Original Articles
Copyright
Copyright © Cambridge University Press 2011

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

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.Google Scholar
Altman, DG, Royston, P (2000). What do we mean by validating a prognostic model? Statistics in Medicine 19, 453473.3.0.CO;2-5>CrossRefGoogle ScholarPubMed
Arnow, BA (2004). Relationships between childhood maltreatment, adult health and psychiatric outcomes, and medical utilization. Journal of Clinical Psychiatry 65 (Suppl. 12), 1015.Google ScholarPubMed
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.CrossRefGoogle ScholarPubMed
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.Google ScholarPubMed
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.Google Scholar
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.CrossRefGoogle ScholarPubMed
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.CrossRefGoogle Scholar
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.CrossRefGoogle ScholarPubMed
Blaxter, M (1990). Health and Lifestyles. Routledge: London.CrossRefGoogle Scholar
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.CrossRefGoogle ScholarPubMed
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.CrossRefGoogle ScholarPubMed
Cooper, H, Hedges, LV (1994). The Handbook of Research Synthesis. Russell Sage Foundation: New York.Google Scholar
Copas, JB (1983). Regression, prediction and shrinkage. Journal of the Royal Statistical Society (Series B) 45, 311354.Google Scholar
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.CrossRefGoogle Scholar
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.CrossRefGoogle Scholar
Drew, E, Emerek, R, Mahon, E (1998). Women, Work, and the Family in Europe. Routledge: London.Google Scholar
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.Google Scholar
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.Google ScholarPubMed
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.CrossRefGoogle ScholarPubMed
Greenland, S (1989). Modeling variables selection in epidemiologic analysis. American Journal of Public Health 79, 340349.CrossRefGoogle ScholarPubMed
Harrell, FE (2001). Regression Modelling Strategies. Springer: New York.CrossRefGoogle Scholar
Hernán, MA, Hernández-Díaz, S, Robins, JM (2004). A structural approach to selection bias. Epidemiology 15, 615625.CrossRefGoogle ScholarPubMed
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.CrossRefGoogle ScholarPubMed
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.CrossRefGoogle ScholarPubMed
Karasek, RA, Theorell, T (1990). Healthy Work: Stress, Productivity, and the Reconstruction of Working Life. Basic Books: New York.Google Scholar
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.CrossRefGoogle ScholarPubMed
King, M, Speck, P, Thomas, A (1995). The Royal Free interview for religious and spiritual beliefs: development and standardization. Psychological Medicine 25, 11251134.CrossRefGoogle Scholar
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.CrossRefGoogle ScholarPubMed
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.CrossRefGoogle ScholarPubMed
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.CrossRefGoogle ScholarPubMed
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.CrossRefGoogle ScholarPubMed
Little, RJA, Rubin, DB (2002). Statistical Analysis with Missing Data, 2nd edn. Wiley: New York.CrossRefGoogle Scholar
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.CrossRefGoogle ScholarPubMed
Moons, KGM, Royston, P, Vergouwe, Y, Grobbee, DE, Altman, DG (2009). Prognosis and prognostic research: what, why, and how? British Medical Journal 338, b375.CrossRefGoogle Scholar
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.CrossRefGoogle ScholarPubMed
Pepe, MS (2003). The Statistical Evaluation of Medical Tests for Classification and Prediction. Oxford University Press: New York.CrossRefGoogle Scholar
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.Google ScholarPubMed
Piccinelli, M, Wilkinson, G (2000). Gender differences in depression. Critical review. British Journal of Psychiatry 177, 486492.CrossRefGoogle ScholarPubMed
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.CrossRefGoogle ScholarPubMed
Rabe-Hesketh, S, Skrondal, A (2008). Multilevel and Longitudinal Modelling Using STATA, 2nd edn. STATA Press: College Station, TX.Google Scholar
Reher, DS (1998). Family ties in Western Europe: persistent contrasts. Population and Development Review 24, 203234.CrossRefGoogle Scholar
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.CrossRefGoogle Scholar
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.CrossRefGoogle ScholarPubMed
Royston, P (2005). Multiple imputation of missing values: update of ice. Stata Journal 5, 527536.CrossRefGoogle Scholar
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.Google ScholarPubMed
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.Google ScholarPubMed
Schafer, JL (1999). Multiple imputation: a primer. Statistical Methods in Medical Research 8, 315.CrossRefGoogle ScholarPubMed
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.CrossRefGoogle ScholarPubMed
Snijders, TAB, Bosker, RJ (1999). Multilevel Analysis. An Introduction to Basic and Advanced Multilevel Modelling. Sage Publications: London.Google Scholar
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.CrossRefGoogle ScholarPubMed
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.Google Scholar
StataCorp (2007). Stata Statistical Software: Release 10. Stata Corporation: College Station, TX.Google Scholar
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.Google Scholar
Weich, S, Lewis, G (1998). Poverty, unemployment, and common mental disorders: population based cohort study. British Medical Journal 317, 115119.CrossRefGoogle ScholarPubMed
Whisman, MA, Uebelacker, LA (2009). Prospective associations between marital discord and depressive symptoms in middle-aged and older adults. Psychology and Aging 24, 184189.CrossRefGoogle ScholarPubMed
WHO (1997). Composite International Diagnostic Interview (CIDI). Version 2.1. World Health Organization: Geneva.Google Scholar
Supplementary material: File

Bellon Supplementary Material

Bellon Supplementary Appendix

Download Bellon Supplementary Material(File)
File 185.3 KB