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From an article titled "Prevalence of Depression in the Community from 30 Countries between 1994 and 2014 (Lim et al., Scientific Reports, 2018)":

A random-effects model meta-analysis that was performed to calculate the aggregate point, one-year and lifetime prevalence of depression calculated prevalences of 12.9%, 7.2% and 10.8% respectively.

Why is the lifetime prevalence lower than point prevalence? It appears to me that lifetime prevalence includes all people who have ever had an episode of depression, and surely a point prevalence would miss some of them, whenever it was assessed. Thus a lower lifetime prevalence looks odd.

Where is my mistake here?

1
  • Can you figure out a way to get a link to the supplementary materials? The references to the 68 studies of point-prevalence, the 9 studies of 1-year prevalence, and the 13 studies of lifetime prevalence are (we hope) provided there. I suspect that the studies of 1-year and lifetime prevalence differ in distribution of continents and HDI but would be able to confirm this without looking at the continent and HDI for the 9 studies of 1-year prevalence and 13 of lifetime prevalence. – Diana Petitti Aug 20 '20 at 18:56
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You have not made a mistake. Point prevalence must be lower than 1-year prevalence and 1-year prevalence must be lower than lifetime prevalence for a population.

In the systematic review, there are 68 studies that provided estimates of point prevalence, 9 that provided estimates of 1-year prevalence and 13 that provided estimates of lifetime prevalence (N=13). Inspecting Figures 1, 2, and 3, there are no studies that provided estimates of point prevalence and also provided an estimate of 1-year prevalence. Similarly, there are no studies that provided an estimate of 1-year prevalence that also provided an estimate of lifetime prevalence. That is, there are no studies of point prevalence, 1-year prevalence, and lifetime prevalence for the same population.

It is not possible to obtain generalizable estimates of the point prevalence, 1-year prevalence, and lifetime prevalence that can be compared from a set of studies that come from different countries and continents, were done at disparate time periods, and used different methods.

The particular studies used to estimate lifetime prevalence are problematic.

Two of the studies used to make the estimate of the lifetime prevalence of depression (Altamura 1995 and Carta 1995) come from Sardinia, a small island off Italy. The study is not generalizable. The publications may present duplicate data.

https://pmlegacy.ncbi.nlm.nih.gov/pubmed/8775767

https://pmlegacy.ncbi.nlm.nih.gov/pubmed/8775768

One of the studies (Beals 2005) was a study of members of Native American tribes living in the Southwest or the Northern Plains.

https://pmlegacy.ncbi.nlm.nih.gov/pubmed/16135632

A total of 3,084 tribal members (1,446 in a Southwest tribe [73.7% of eligible participants] and 1,638 in a Northern Plains tribe [76.8% of eligible participants]) age 15-54 years living on or near their home reservations were interviewed.

One of the studies (Ialongo 2004) was a study that involved predominantly poor, young, African-Americans living in Baltimore.

https://pmlegacy.ncbi.nlm.nih.gov/pubmed/15023487

The present report describes the prevalence of major depressive disorder (MDD) in an epidemiologically-defined population of 1197, predominately poor, African-American 19-22-year-olds, living in the greater Baltimore, MD metropolitan area.

One of the studies (Pakriev 2009) was a study of 323 adult inpatients in Russia.

https://pmlegacy.ncbi.nlm.nih.gov/pubmed/19551555

The particular estimate of the lifetime prevalence of depression for the Smith (2013) study in the meta-analysis is 6.4%. But Smith 2013 reported separate estimates of the lifetime prevalence of a single episode of depression (6.4%), probable recurrent major depression (moderate) (12.2%), and probable recurrent major depression (severe) (7.2%). These should have been added to estimate the lifetime prevalence of any major depression--25.8% instead of 6.4%. This study, because of its size (172,751 people), heavily weights the summary estimate of prevalence and the mistake is serious.

https://pmlegacy.ncbi.nlm.nih.gov/pubmed/24282498

Prevalence rates for probable single lifetime episode of major depression (6.4%), probable recurrent major depression (moderate) (12.2%), probable recurrent major depression (severe) (7.2%) and probable bipolar disorder (1.3%) were comparable to those found in other population studies.

In the 1990’s, there was an international effort aimed at understanding international differences in the lifetime prevalence of depression using common methods.

https://pmlegacy.ncbi.nlm.nih.gov/pubmed/12830306

Andrade L, Caraveo-Anduaga JJ, Berglund P, Bijl RV, De Graaf R, Vollebergh W, Dragomirecka E, Kohn R, Keller M, Kessler RC, Kawakami N, Kiliç C, Offord D, Ustun TB, Wittchen HU. The epidemiology of major depressive episodes: results from the International Consortium of Psychiatric Epidemiology (ICPE) Surveys. Int J Methods Psychiatr Res. 2003;12(1):3-21. Erratum in: Int J Methods Psychiatr Res. 2003;12(3):165. PubMed PMID: 12830306; PubMed Central PMCID: PMC6878531.

Community epidemiological surveys using the World Health Organization Composite International Diagnostic Interview administered face-to-face were carried out in 10 countries in North America (Canada and the US), Latin America (Brazil, Chile, and Mexico), Europe (Czech Republic, Germany, the Netherlands, and Turkey), and Asia (Japan). The total sample size was more than 37,000. Lifetime prevalence estimates of hierarchy-free DSM-III-R/DSM-IV MDE varied widely, from 3% in Japan to 16.9% in the US, with the majority in the range of 8% to 12%.

  REFERENCES TO STUDIES THAT PROVIDED ESTIMATES OF LIFETIME PREVALENCE OF DEPRESSION

Altamura AC, Carta MG, Carpiniello B, Piras A, Macciò MV, Marcia L. Lifetime prevalence of brief recurrent depression (results from a community survey). Eur Neuropsychopharmacol. 1995;5 Suppl:99-102. PubMed PMID: 8775767.

Angst J. The epidemiology of depressive disorders. Eur Neuropsychopharmacol. 1995;5 Suppl:95-8. PubMed PMID: 8775766.

Beals J, Manson SM, Whitesell NR, Mitchell CM, Novins DK, Simpson S, Spicer P. Prevalence of major depressive episode in two American Indian reservation populations: unexpected findings with a structured interview. Am J Psychiatry. 2005 Sep;162(9):1713-22. PubMed PMID: 16135632.

Blazer DG, Kessler RC, McGonagle KA, Swartz MS. The prevalence and distribution of major depression in a national community sample: the National Comorbidity Survey. Am J Psychiatry. 1994 Jul;151(7):979-86. PubMed PMID: 8010383.

Carta MG, Carpiniello B, Kovess V, Porcedda R, Zedda A, Rudas N. Lifetime prevalence of major depression and dysthymia: results of a community survey in Sardinia. Eur Neuropsychopharmacol. 1995;5 Suppl:103-7. PubMed PMID: 8775768.

Chang SM, Hahm BJ, Lee JY, Shin MS, Jeon HJ, Hong JP, Lee HB, Lee DW, Cho MJ. Cross-national difference in the prevalence of depression caused by the diagnostic threshold. J Affect Disord. 2008 Feb;106(1-2):159-67. Epub 2007 Aug 28. PubMed PMID: 17725930.

Ialongo N, McCreary BK, Pearson JL, Koenig AL, Schmidt NB, Poduska J, Kellam SG. Major depressive disorder in a population of urban, African-American young adults: prevalence, correlates, comorbidity and unmet mental health service need. J Affect Disord. 2004 Apr;79(1-3):127-36. PubMed PMID: 15023487.

Kessler RC, Berglund P, Demler O, Jin R, Koretz D, Merikangas KR, Rush AJ, Walters EE, Wang PS; National Comorbidity Survey Replication. The epidemiology of major depressive disorder: results from the National Comorbidity SurveyReplication (NCS-R). JAMA. 2003 Jun 18;289(23):3095-105. PubMed PMID: 12813115.

Kessler RC, Zhao S, Blazer DG, Swartz M. Prevalence, correlates, and course of minor depression and major depression in the National Comorbidity Survey. JAffect Disord. 1997 Aug;45(1-2):19-30. PubMed PMID: 9268772.

Orui M, Kawakami N, Iwata N, Takeshima T, Fukao A. Lifetime prevalence of mental disorders and its relationship to suicidal ideation in a Japanese rural community with high suicide and alcohol consumption rates. Environ Health Prev Med. 2011 Nov;16(6):384-9. doi: 10.1007/s12199-011-0209-y. Epub 2011 Feb 23. PubMed PMID: 21431807; PubMed Central PMCID: PMC3206975.

Pakriev S, Kovalev J, Mozhaev M. Prevalence of depression in a general hospital in Izhevsk, Russia. Nord J Psychiatry. 2009 Nov;63(6):469-74. doi: 10.3109/08039480903062950. PubMed PMID: 19551555.

Smith DJ, Nicholl BI, Cullen B, Martin D, Ul-Haq Z, Evans J, Gill JM, Roberts B, Gallacher J, Mackay D, Hotopf M, Deary I, Craddock N, Pell JP. Prevalence and characteristics of probable major depression and bipolar disorder within UK biobank: cross-sectional study of 172,751 participants. PLoS One. 2013 Nov 25;8(11):e75362. doi: 10.1371/journal.pone.0075362. eCollection 2013. PubMed PMID: 24282498; PubMed Central PMCID: PMC3839907.

Tomlinson M, Grimsrud AT, Stein DJ, Williams DR, Myer L. The epidemiology of major depression in South Africa: results from the South African stress and health study. S Afr Med J. 2009 May;99(5 Pt 2):367-73. PubMed PMID: 19588800; PubMed Central PMCID: PMC3195337.

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