Development and Validation of an International Risk Prediction Algorithm for Episodes of Major Depression in General Practice Attendees

• DOI: 10.1001/archpsyc.65.12.1368
• Publication Date: 2008-12-01T21:17:16Z
• Authors: Michael King; Carl Walker; Gus Levy; Christian Bottomley; Patrick Royston; Scott Weich; Juan Ángel Bellón...; Berta Moreno; Igor Švab; Danica Rotar; J. Rifel; Heidi-Ingrid Maaroos; Anu Aluoja; Ruth Kalda; Jan Neeleman; Mirjam I. Geerlings; Miguel Xavier; Idalmiro Carraça; Manuel Gonçalves-...; Benjamin Vicente; Sandra Saldivia; Roberto Melipillan; Francisco Torres-...; Irwin Nazareth
• Keywords: Adult; Male; OLD AGE.; Adolescent; POPULATION-BASED COHORT; GOSPEL OAK PROJECT; Risk Assessment; 03 medical and health sciences; 0302 clinical medicine; Predictive Value of Tests; Humans; INDEX; Aged; Depressive Disorder, Major; PRIMARY-CARE; Middle Aged; 16. Peace & justice; 300; DIFFERENT CULTURES; PREVALENCE; 3. Good health; INTERVIEW; C880 Social Psychology; COMMON MENTAL-DISORDERS; Female; HEALTH; Family Practice; Algorithms

Strategies for prevention of depression are hindered by lack of evidence about the combined predictive effect of known risk factors.To develop a risk algorithm for onset of major depression.Cohort of adult general practice attendees followed up at 6 and 12 months. We measured 39 known risk factors to construct a risk model for onset of major depression using stepwise logistic regression. We corrected the model for overfitting and tested it in an external population.General practices in 6 European countries and in Chile.In Europe and Chile, 10 045 attendees were recruited April 2003 to February 2005. The algorithm was developed in 5216 European attendees who were not depressed at recruitment and had follow-up data on depression status. It was tested in 1732 patients in Chile who were not depressed at recruitment. Main Outcome Measure DSM-IV major depression.Sixty-six percent of people approached participated, of whom 89.5% participated again at 6 months and 85.9%, at 12 months. Nine of the 10 factors in the risk algorithm were age, sex, educational level achieved, results of lifetime screen for depression, family history of psychological difficulties, physical health and mental health subscale scores on the Short Form 12, unsupported difficulties in paid or unpaid work, and experiences of discrimination. Country was the tenth factor. The algorithm's average C index across countries was 0.790 (95% confidence interval [CI], 0.767-0.813). Effect size for difference in predicted log odds of depression between European attendees who became depressed and those who did not was 1.28 (95% CI, 1.17-1.40). Application of the algorithm in Chilean attendees resulted in a C index of 0.710 (95% CI, 0.670-0.749).This first risk algorithm for onset of major depression functions as well as similar risk algorithms for cardiovascular events and may be useful in prevention of depression.