Simulation studies of age-specific lifetime major depression prevalence

BMC Psychiatry

Research Article

Scott B Patten¹  Lee Gordon-Brown²  Graham Meadows³ 

[1] Department of Community Health Sciences & Department of Psychiatry, University of Calgary, 3330 Hospital Drive NW, T2N 4N1, Calgary, AB, Canada;Econometrics & Business Statistics, Monash University, Melbourne, VIC, Australia;Monash Univ, Sch Psychol Psychiat & Psychol Med, 3004, Melbourne, Vic, Australia;

关键词: Major Depressive Disorder;    Birth Cohort;    False Negative Rate;    Lifetime Prevalence;    Cohort Effect;   

DOI  :  10.1186/1471-244X-10-85

 received in 2009-10-03, accepted in 2010-10-20,  发布年份 2010

来源: Springer

【 摘 要 】

BackgroundThe lifetime prevalence (LTP) of Major Depressive Disorder (MDD) is the proportion of a population having met criteria for MDD during their life up to the time of assessment. Expectation holds that LTP should increase with age, but this has not usually been observed. Instead, LTP typically increases in the teenage years and twenties, stabilizes in adulthood and then begins to decline in middle age. Proposed explanations for this pattern include: a cohort effect (increasing incidence in more recent birth cohorts), recall failure and/or differential mortality. Declining age-specific incidence may also play a role.MethodsWe used a simulation model to explore patterns of incidence, recall and mortality in relation to the observed pattern of LTP. Lifetime prevalence estimates from the 2002 Canadian Community Health Survey, Mental Health and Wellbeing (CCHS 1.2) were used for model validation and calibration.ResultsIncidence rates predicting realistic values for LTP in the 15-24 year age group (where mortality is unlikely to substantially influence prevalence) lead to excessive LTP later in life, given reasonable assumptions about mortality and recall failure. This suggests that (in the absence of cohort effects) incidence rates decline with age. Differential mortality may make a contribution to the prevalence pattern, but only in older age categories. Cohort effects can explain the observed pattern, but only if recent birth cohorts have a much higher (approximately 10-fold greater) risk and if incidence has increased with successive birth cohorts over the past 60-70 years.ConclusionsThe pattern of lifetime prevalence observed in cross-sectional epidemiologic studies seems most plausibly explained by incidence that declines with age and where some respondents fail to recall past episodes. A cohort effect is not a necessary interpretation of the observed pattern of age-specific lifetime prevalence.

【 授权许可】

CC BY   
© Patten et al; licensee BioMed Central Ltd. 2010