Abstract
Global Burden of Disease (GBD) estimates have significant policy implications nationally and internationally. Disease burden metrics, particularly for depression, have played a critical role in raising governmental awareness of mental health and in calculating the economic cost of depression. Recently, the World Health Organization ranked depression as the single largest contributor to global disability. The main aim of this paper was to assess the basis upon which GBD prevalence estimates for major depressive disorder (MDD) were made. We identify the instruments used in the 2019 GBD estimates and provide a descriptive assessment of the five most frequently used instruments. The majority of country studies, 356/566 (62.9%), used general mental health screeners or structured/semi-structured interview guides, 98/566 (17.3%) of the studies used dedicated depression screeners, and 112 (19.8%) used other tools for assessing depression. Thus, most of the studies used instruments that were not designed to make a diagnosis of depression or assess depression severity. Our results are congruent with and extend previous research that has identified critical flaws in the data underpinning the GBD estimates for MDD. Despite the widespread promotion of these prevalence estimates, caution is needed before using them to inform public policy and mental health interventions. This is particularly important in lower-income countries where resources are scarce.
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Bayetti, C., Bakhshi, P., Davar, B., Khemka, G. C., Kothari, P., Kumar, M., Kwon, W., Mathias, K., Mills, C., Montenegro, C. R., Trani, J. F., & Jain, S. (2023). Critical reflections on the concept and impact of “scaling up” in Global Mental Health. Transcultural Psychiatry, 60(3), 602–609. https://doi.org/10.1177/13634615231183928
Brhlikova, P., Pollock, A. M., & Manners, R. (2011). Global Burden of Disease estimates of depression–how reliable is the epidemiological evidence? Journal of the Royal Society of Medicine, 104(1), 25–34. https://doi.org/10.1258/jrsm.2010.100080
Chapman, A. R. (2010). The social determinants of health, health equity, and human rights. Health and Human Rights, 12(2), 17–30.
Chisholm, D., Sweeny, K., Sheehan, P., Rasmussen, B., Smit, F., Cuijpers, P., & Saxena, S. (2016). Scaling-up treatment of depression and anxiety: A global return on investment analysis. The Lancet. Psychiatry, 3(5), 415–424. https://doi.org/10.1016/S2215-0366(16)30024-4
Copeland, J. R., Prince, M., Wilson, K. C., Dewey, M. E., Payne, J., & Gurland, B. (2002). The Geriatric Mental State Examination in the 21st century. International Journal of Geriatric Psychiatry, 17(8), 729–732. https://doi.org/10.1002/gps.667eferences
Cosgrove, L., D’Ambrozio, G., Herrawi, F., Freeman, M., & Shaughnessy, A. (2023). Why psychiatry needs an honest dose of gentle medicine. Frontiers in Psychiatry, 14, 664. https://doi.org/10.3389/fpsyt.2023.1167910
Global Health Data Exchange. (n.d.). Global burden of disease study 2019 (GBD 2019) Data Input Sources Tool. Global Health Data Exchange (GHDx). https://ghdx.healthdata.org/gbd-2019/data-input-sources?components=5&causes=568&locations=1. Accessed March 2023
Fried, E. I. (2017). The 52 symptoms of major depression: Lack of content overlap among seven common depression scales. Journal of Affective Disorders, 208, 191–197. https://doi.org/10.1016/j.jad.2016.10.019
Goldhill, O. (2023). How a depression test devised by a Zoloft marketer became a crutch for a failing mental health system. STAT News. Retrieved May 2024 from https://www.statnews.com/2023/02/21/depression-test-phq9-zoloft-pfizer-mental-health/
Jerant, A., Kravitz, R. L., Fernandez Y Garcia, E., Feldman, M. D., Cipri, C., Nishio, D., Knoepfler, A., Wooddell, M. K., Baquero, V., & Franks, P. (2014). Potential antidepressant overtreatment associated with office use of brief depression symptom measures. Journal of the American Board of Family Medicine : JABFM, 27(5), 611–620. https://doi.org/10.3122/jabfm.2014.05.140038
Karlsson, L., Marttunen, M., Karlsson, H., Kaprio, J., & Hillevi, A. (2010). Minor change in the diagnostic threshold leads into major alteration in the prevalence estimate of depression. Journal of Affective Disorders., 122, 96–101.
Lancet Global Mental Health Group, Chisholm, D., Flisher, A. J., Lund, C., Patel, V., Saxena, S., Thornicroft, G., & Tomlinson, M. (2007). Scale up services for mental disorders: A call for action. Lancet (london, England), 370(9594), 1241–1252. https://doi.org/10.1016/S0140-6736(07)61242-2
Lecrubier, Y., Sheehan, D. V., Weiller, E., Amorim, P., Bonora, I., Sheehan, K. H., Janavs, J., & Dunbar, G. C. (1997). The Mini International Neuropsychiatric Interview (MINI): A short diagnostic structured interview: Reliability and validity according to the CIDI. European Psychiatry, 12(5), 224–231. https://doi.org/10.1016/S0924-9338(97)83296-8
Levis, B., Benedetti, A., Riehm, K. E., Saadat, N., Levis, A. W., Azar, M., et al. (2018). Probability of major depression diagnostic classification using semi-structured versus fully structured diagnostic interviews. The British Journal of Psychiatry, 212(6), 377–385. https://doi.org/10.1192/bjp.2018.54
Levis, B., Benedetti, A., Ioannidis, J. P. A., Sun, Y., Negeri, Z., He, C., et al. (2020). Patient health questionnaire-9 scores do not accurately estimate depression prevalence: Individual participant data meta-analysis. Journal of Clinical Epidemiology, 122, 115.e1–128.e1. https://doi.org/10.1016/j.jclinepi.2020.02.002
Lyus, R., Buamah, C., Pollock, A. M., Cosgrove, L., & Brhlikova, P. (2023). Global Burden of Disease 2017 estimates for Major Depressive Disorder: A critical appraisal of the epidemiological evidence. JRSM Open, 14(9), 20542704231197590. https://doi.org/10.1177/20542704231197594
Maske, U. E., Busch, M. A., Jacobi, F., Beesdo-Baum, K., Seiffert, I., Wittchen, H. U., Riedel-Heller, S., & Hapke, U. (2015). Current major depressive syndrome measured with the Patient Health Questionnaire-9 (PHQ-9) and the Composite International Diagnostic Interview (CIDI): Results from a cross-sectional population-based study of adults in Germany. BMC Psychiatry, 15, 77. https://doi.org/10.1186/s12888-015-0463-4
Mekonen, T., Chan, G. C. K., Connor, J. P., Hides, L., & Leung, J. (2021). Estimating the global treatment rates for depression: A systematic review and meta-analysis. Journal of Affective Disorders, 295, 1234–1242. https://doi.org/10.1016/j.jad.2021.09.038
Merriott, D. (2016). Factors associated with the farmer suicide crisis in India. Journal of Epidemiology and Global Health, 6(4), 217–227.
Mezzich, J. E., Kirmayer, L. J., Kleinman, A., Fabrega, H., Parron, D. L., Good, B. J., Lin, K. M., & Manson, S. M. (1999). The place of culture in DSM-IV. Journal of Nervous and Mental Disease, 187(8), 457–464. https://doi.org/10.1097/00005053-199908000-00001
Patel, V., Collins, P. Y., Copeland, J., Kakuma, R., Katontoka, S., Lamichhane, J., et al. (2011). The movement for Global Mental Health. The British Journal of Psychiatry, 198(2), 88–90. https://doi.org/10.1192/bjp.bp.109.074518
Patel, V., Saxena, S., Lund, C., Thornicroft, G., Baingana, F., Bolton, P., Chisholm, D., Collins, P. Y., Cooper, J. L., Eaton, J., Herrman, H., Herzallah, M. M., Huang, Y., Jordans, M. J. D., Kleinman, A., Medina-Mora, M. E., Morgan, E., Niaz, U., Omigbodun, O., … UnÜtzer, J. (2018). The Lancet Commission on global mental health and sustainable development. Lancet (london, England), 392(10157), 1553–1598. https://doi.org/10.1016/S0140-6736(18)31612-X
Pettersson, A., Boström, K. B., Gustavsson, P., & Ekselius, L. (2015). Which instruments to support diagnosis of depression have sufficient accuracy? A systematic review. Nordic Journal of Psychiatry, 69(7), 497–508. https://doi.org/10.3109/08039488.2015.1008568
Pūras, D. (2017). Statement by Mr Dainius Pūras, Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health at the 35th session of the Human Rights Council. United Nations. https://www.ohchr.org/en/statements/2017/09/statement-mr-dainius-puras-special-rapporteur-right-everyone-enjoyment-highest
Robins, L. N., Wing, J., Wittchen, H. U., Helzer, J. E., Babor, T. F., Burke, J., Farmer, A., Jablenski, A., Pickens, R., & Regier, D. A. (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(12), 1069–1077. https://doi.org/10.1001/archpsyc.1988.01800360017003
Roseman, M., Kloda, L. A., Saadat, N., Riehm, K. E., Ickowicz, A., Baltzer, F., Katz, L. Y., Patten, S. B., Rousseau, C., & Thombs, B. D. (2016). Accuracy of depression screening tools to detect major depression in children and adolescents: A systematic review. Canadian Journal of Psychiatry. Revue Canadienne De Psychiatrie, 61(12), 746–757. https://doi.org/10.1177/0706743716651833
Summerfield, D. A. (2017). Western depression is not a universal condition. The British Journal of Psychiatry: THe Journal of Mental Science, 211(1), 52. https://doi.org/10.1192/bjp.211.1.52
Thombs, B. D., Kwakkenbos, L., Levis, A. W., & Benedetti, A. (2018). Addressing overestimation of the prevalence of depression based on self-report screening questionnaires. CMAJ : Canadian Medical Association Journal = Journal De L’association Medicale Canadienne, 190(2), E44–E49. https://doi.org/10.1503/cmaj.170691
Tichenor, M., & Sridhar, D. (2019). Metric partnerships: global burden of disease estimates within the World Bank, the World Health Organisation and the Institute for Health Metrics and Evaluation. Wellcome Open Research, 4, 35. https://doi.org/10.12688/wellcomeopenres.15011.2
Wang, P. S., Aguilar-Gaxiola, S., Alonso, J., Angermeyer, M. C., Borges, G., Bromet, E. J., Bruffaerts, R., de Girolamo, G., de Graaf, R., Gureje, O., Haro, J. M., Karam, E. G., Kessler, R. C., Kovess, V., Lane, M. C., Lee, S., Levinson, D., Ono, Y., Petukhova, M., … Wells, J. E. (2007). Use of mental health services for anxiety, mood, and substance disorders in 17 countries in the WHO world mental health surveys. Lancet (london, England), 370(9590), 841–850. https://doi.org/10.1016/S0140-6736(07)61414-7
Wildeman, S. (2013). Protecting rights and building capacities: Challenges to global mental health policy in light of the convention on the rights of persons with disabilities. The Journal of Law, Medicine & Ethics : A Journal of the American Society of Law, Medicine & Ethics, 41(1), 48–73. https://doi.org/10.1111/jlme.12005
Williams, C., & Chapman, A. (2022). VIRTUAL ROUNDTABLE Impact of human rights council reports on mental health. Health and Human Rights Journal, 25(2). 85–99. Retrieved May 2024 from https://www.hhrjournal.org/2022/12/virtual-roundtable-impact-of-human-rights-council-reports-on-mental-health/
World Health Organization. (WHO). (2017, January). Depression and Other Common Mental Disorders: Global Health Estimates. Geneva: World Health Organization. https://www.who.int/publications/i/item/depression-global-health-estimates
Yamin, A. E. (2019). Struggles for human rights in health in an age of neoliberalism: From civil disobedience to epistemic disobedience. Journal of Human Rights Practice, 11, 357–372. https://ssrn.com/abstract=3791014
Zeira, A. (2022). Mental health challenges related to neoliberal capitalism in the United States. Community Mental Health Journal, 58(2), 205–212. https://doi.org/10.1007/s10597-021-00840-7
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Cosgrove, L., Brhlikova, P., Lyus, R. et al. Global Burden Disease Estimates for Major Depressive Disorders (MDD): A review of diagnostic instruments used in studies of prevalence. Community Ment Health J (2024). https://doi.org/10.1007/s10597-024-01302-6
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DOI: https://doi.org/10.1007/s10597-024-01302-6