Global Burden of Disease estimates of depression - how reliable is the epidemiological evidence?
Global Burden of Disease estimates of depression - how reliable is the epidemiological evidence?
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DOI：
10.1258/jrsm.2010.100080
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发表时间：
2011-01-01
影响因子：
17.3
通讯作者：
Manners, Rachel
中科院分区：
文献类型：
--
作者：
Brhlikova, Petra;Pollock, Allyson M.;Manners, Rachel
目的重新评估用于评估2000年全球抑郁症负担的流行病学研究的质量。设计确定用于全球抑郁症负担评估的主要和次要数据来源，并将其分配给来源国。对每个来源进行了国家/区域估计的完整性和代表性的评估，并对照科学小组使用的纳入标准来评估GBDep.设置不适用。参与者不适用。主要结果衡量标准不适用。结果第一，国家估计：GBDep研究中引用的28个科学来源与191个世卫组织成员国中的40个有关。欧元区对52个国家中的15个国家进行了研究，而非洲区域只对46个国家中的3个国家进行了研究。在40个国家中，只有6个国家的数据来自具有国家代表性的人口：三项非洲国家研究基于单个村庄或城镇，同样，东南亚区域经济共同体区域没有具有国家代表性的数据；第二，GBDep标准：GBDep纳入标准要求研究样本规模超过1000人；42项研究中有19项(45%)不符合这一标准。在36项研究中，有16项(44%)不符合研究显示明确样本框架和方法的要求。GBD估计依赖于发病率估计；42项国家研究中只有两项提供了发病率数据(加拿大和挪威)，其余34项研究是流行率研究。抑郁症的持续时间基于在美国和荷兰进行的三项研究。结论大多数研究在研究设计和分析以及遵守GBDep纳入标准方面存在明显的缺陷和局限性。质量差的数据限制了全球抑郁症负担估计的解释和有效性。不加批判地将这些估计应用于国际医疗政策制定，可能会将稀缺资源从其他公共医疗优先事项上分流出来。
Objectives To re-assess the quality of the epidemiological studies used to estimate the global burden of depression 2000, as published in the GBDep study.Design Primary and secondary data sources used in the global burden of depression estimate were identified and assigned to country of origin. Each source was assessed with respect to completeness and representativeness for national/regional estimates and against the inclusion criteria used by the scientific team estimating GBDep.Setting Not applicable.Participants Not applicable.Main outcome measures Not applicable.Results First, National estimates: The 28 scientific sources cited in the GBDep study related to 40 of the 191 WHO member countries. The EURO region had studies relating to 15 of 52 countries whereas AFRO region had studies for only three of 46 countries. Only six of the 40 countries had data drawn from a nationally representative population: the three AFRO country studies were based on a single village or town and, likewise, SEARO region had no nationally representative data; second, GBDep criteria: GBDep inclusion criteria required study sample size of more than 1000 people; 19 (45%) of the 42 studies did not meet this criterion. Sixteen (44%) of 36 studies did not meet the requirement that studies show a clear sample frame and method. GBD estimates rely on estimates of incidence; only two of the 42 country studies provided incidence data (Canada and Norway), the remaining 34 studies were prevalence studies. Duration of depression is based on three studies conducted in the USA and Holland.Conclusions Most studies exhibit significant shortcomings and limitations with respect to study design and analysis and compliance with GBDep inclusion criteria. Poor quality data limit the interpretation and validity of global burden of depression estimates. The uncritical application of these estimates to international healthcare policy-making could divert scarce resources from other public healthcare priorities.