Background
Methods
Study 1. Systematic review of validated depression case definitions
Search strategy
Study selection
Data extraction
Quality assessment
Study 2. Validation of depression case definitions in hospital discharge data
Administrative data source
Study population and chart review
Coding algorithms
Case definition | Codes employed | Sensitivity (%) (95% CI) | Specificity (%) (95% CI) | Positive predictive value (%) (95% CI) | Negative predictive value (%) (95% CI) |
---|---|---|---|---|---|
Alaghehbandan (2012) 1 | ICD-9: 311 | 19.92 (16.42-23.79) | 99.69 (99.44-99.84) | 89.62 (82.19-94.70) | 90.21 (89.23-91.13) |
Alaghehbandan (2012) 2 | ICD-10-CA: F32.0-F32.3, F32.8, F32.9, F33.0-F33.4, F33.8, F34.1 | 29.56 (25.50-33.88) | 99.58 (99.30-99.76) | 90.38 (84.64-94.52) | 91.28 (90.34-92.15) |
Noyes (2011) 1 | ICD-9: 296.20-.24, 296.30.-34 | 1.05 (0.34-2.43) | 100.00 (99.90-100.00) | 100.00 (47.82-100.00) | 88.21 (87.17-89.19) |
Noyes (2011) 2 | ICD-9: 296.20-.24, 296.30-.34, 300.4, 311 | 28.93 (24.90-33.23) | 99.66 (99.41-99.82) | 92.00 (86.44-95.80) | 91.21 (90.28-92.09) |
Singh (2006) | ICD-9: 296.xx, 300.4, 301.1x, 298, 311 | 28.90 (24.9-33.2) | 99.70 (99.40-99.80) | 92.00 (86.40-95.80) | 91.20 (90.30-92.10) |
ICD-9-CM (new definitions tested) | |||||
Case Definition 1* | 296.20-.25, 296.30-.35, 300.4, & 311 | 28.93 (24.90-33.23) | 99.66 (99.41-99.82) | 92.00 (86.44-95.80) | 91.21 (90.28-92.09) |
Case Definition 2* | CD1 + 296.5, 296.6, 296.82 & 296.90 | 29.14 (25.10-33.34) | 99.52 (99.23-99.72) | 89.10 (83.13-93.52) | 91.23 (90.29-92.10) |
Case Definition 3* | CD2 + 309.0, 309.1 & 309.28 | 32.91 (28.71-37.33) | 99.49 (99.20-99.70) | 89.71 (84.23-93.79) | 91.65 (90.73-92.51) |
ICD-10 (new definitions tested) | |||||
Case Definition 4** | F32.0-32.9, F33.0-33.3, F33.8, F33.9, F34.1 & F41.2 | 34.17 (29.92-38.62) | 99.55 (99.27-99.74) | 91.06 (85.89-94.80) | 91.80 (90.89-92.65) |
Case Definition 5** | CD4 + F31.3-F31.6 | 34.59 (30.32-39.05) | 99.52 (99.23-99.72) | 90.66 (85.47-94.46) | 91.85 (90.93-92.69) |
Case Definition 6** | CD5 + F34.8, F34.9, F38.0, F38.1, F38.8, F39, F99 | 35.64 (31.34-40.12) | 99.43 (99.13-99.65) | 89.47 (84.21-93.45) | 91.96 (91.05-92.80) |
ICD-10-CA Code | Definition | ICD-9-CM Code | Definition | |
---|---|---|---|---|
F31.31 | Bipolar affective disorder, current episode mild or moderate depression | <=> | 296.51 | Bipolar I disorder, most recent episode (or current) mild depression |
F31.32 | Bipolar affective disorder, current episode mild or moderate depression | <=> | 296.52 | Bipolar I disorder, most recent episode (or current) moderate depression |
F31.4 | Bipolar affective disorder, current episode severe depression without psychotic symptoms | <=> | 296.53 | Bipolar I disorder, most recent episode (or current) severe without mention of psychotic behavior |
F31.5 | Bipolar affective disorder, current episode severe depression with psychotic symptoms | <=> | 296.54 | Bipolar I disorder, most recent episode (or current) severe specified as with psychotic behavior |
F31.6x | Bipolar affective disorder, current episode mixed | <=> | 296.6x | Bipolar I disorder, most recent episode (or current) mixed |
F31.9 | Bipolar affective disorder, current episode unspecified | |||
F32.0 | Mild depressive episode | <=> | 296.21 | Major depressive disorder, single episode- mild |
F32.1 | Moderate depressive episode | <=> | 296.22 | Major depressive disorder, single episode- moderate |
F32.2 | Severe depressive episode without psychotic symptoms | <=> | 296.23 | Major depressive disorder, single episode- severe, without mention of psychotic behavior |
F32.3 | Severe depressive episode with psychotic symptoms | <=> | 296.24 | Major depressive disorder, single episode- severe, specified as with psychotic behavior |
F32.4 | Depressive disorder, single episode, in partial remission | <=> | 296.25 | Major depressive disorder, single episode- in partial or unspecified remission |
F32.5 | Depressive disorder, single episode, in full remission | <=> | 296.26 | Major depressive disorder, single episode- in full remission |
F32.8 | Other depressive episodes | <=> | 296.82 | Atypical depressive disorder |
F32.9 | Depressive episode, unspecified | <=> | 296.20 | Major depressive disorder, single episode- unspecified |
F32.9 | Depressive episode, unspecified | <=> | 311 | Depressive disorder, not elsewhere classified |
F33.0 | Recurrent depressive disorder, current episode mild | <=> | 296.31 | Major depressive disorder, recurrent episode- mild |
F33.1 | Recurrent depressive disorder, current episode moderate | <=> | 296.32 | Major depressive disorder, recurrent episode- moderate |
F33.2 | Recurrent depressive disorder, current episode severe without psychotic symptoms | <=> | 296.33 | Major depressive disorder, recurrent episode- severe, without mention of psychotic behavior |
F33.3 | Recurrent depressive disorder, current episode severe with psychotic symptoms | <=> | 296.34 | Major depressive disorder, recurrent episode- severe, specified as with psychotic behavior |
F33.41 | Recurrent depressive disorder, currently in remission | <=> | 296.35 | Major depressive disorder, recurrent episode- in partial or unspecified remission |
F33.42 | Recurrent depressive disorder, currently in remission | <=> | 296.36 | Major depressive disorder, recurrent episode- in full remission |
F33.8 | Recurrent depressive disorder, other | |||
F33.9 | Recurrent depressive disorder, unspecified | <=> | 296.30 | Major depressive disorder, recurrent episode- unspecified |
F34.1 | Dysthymia | <=> | 300.4 | Dysthymic disorder |
F34.8 | Other persistent mood disorders | <=> | ||
F34.9 | Persistent mood disorder, unspecified | <=> | ||
F38.0 | Other single mood disorders | <=> | ||
F38.1 | Other recurrent mood disorders | <=> | ||
F38.8 | Other specified mood disorders | <=> | 296.99 | Other specified episodic mood disorder |
F39 | Unspecified mood disorder | <=> | 296.90 | Unspecified episodic mood disorder |
F41.2 | Mixed anxiety and depressive disorder | <=> | ||
F43.2 | Adjustment Disorders | <=> | 309.0 | Adjustment disorder with depressed mood |
F43.2 | Adjustment Disorders | <=> | 309.28 | Adjustment disorder with mixed anxiety and depressed mood |
F99 | Mental disorder, not elsewhere specified | |||
296.82 | Atypical depressive disorder | |||
298 | Other non-organic depressive psychoses | |||
309.1 | Prolonged depressive reaction | |||
NOTE: ICD = International Classification of Disease |
Statistical analyses
Results
Study 1. Systematic review of validated depression case definitions
Identification and description of studies
Author | Country | N | Year of data collection | Administrative database | Reference standard | ICD codes | Prevalence (%) | Sensitivity (%) | Specificity (%) | PPV (%) | NPV (%) |
---|---|---|---|---|---|---|---|---|---|---|---|
Alaghehbandan (2012) | Canada | 510 | 1995-2008 | Provincial Hospital Separation Database; Provincial fee-for-service physician claims database | Electronic Medical Record and Medical Chart Review | ICD-9: 311; ICD-10-CA: F32.0-F32.3, F32.8, F32.9, F33.0-F33.4, F33.8, F34.1 | NR | ||||
≥ 1 Hospital OR ≥2 Physician within 1 Year | 70.0 | 93.8 | 91.7 | 76.0 | |||||||
≥ 1 Hospital OR ≥2 Physician within 2 Years | 75.1 | 93.0 | 91.3 | 79.1 | |||||||
( ≥1 Hospital OR ≥1 PSY) OR ≥2GP within 1 Year | 73.1 | 93.4 | 91.6 | 77.9 | |||||||
( ≥1 Hospital OR ≥1 PSY) OR ≥2 GP within 2 Years | 77.5 | 93.0 | 91.6 | 80.7 | |||||||
( ≥1 Hospital OR ≥1 PSY) OR ≥3 GP within 3 Years | 69.6 | 93.4 | 91.2 | 75.7 | |||||||
Noyes (2011) | USA | 1,605 | 1998-2002 | Medicare | Previous MDE, GDS, or MINI-MDE | ICD-9: 296.20-.24, 296.30-.34 | 18% based on MINI | ||||
MDE at baseline- claims diagnoses at 6 months before & after baseline | 14.13 | 95.61 | 41.05 | 83.72 | |||||||
MDE at baseline- claims diagnoses at 12 months before & after baseline | 18.12 | 93.45 | 37.31 | 84.14 | |||||||
GDS ≥6 at baseline- claims diagnoses at 6 months before & after baseline | 9.96 | 95.60 | 55.42 | 65.90 | |||||||
GDS ≥6 at baseline- claims diagnoses at 12 months before & after baseline | 12.69 | 93.26 | 50.86 | 66.03 | |||||||
MINI-MDE at baseline- claims diagnoses at 6 months before and after baseline | ICD-9: 296.20-.24, 296.30-.34, 300.4, 309.0, 311 | 33.70 | 82.12 | 28.97 | 85.12 | ||||||
MINI-MDE at baseline- claims diagnoses at 12 months before and after baseline | 46.38 | 74.98 | 28.51 | 86.67 | |||||||
GDS ≥6 at baseline- claims diagnoses at 6 months before and after baseline | 27.92 | 83.35 | 47.96 | 67.79 | |||||||
GDS ≥6 at baseline- claims diagnoses at 12 months before and after baseline | 39.57 | 77.42 | 49.07 | 69.98 | |||||||
GDS ≥11 at baseline- claims diagnoses at 6 months before and after baseline | ICD-9: 296.20-.24, 296.30-.34 | 55.06 | 73.32 | 13.07 | 95.73 | ||||||
GDS ≥11 at baseline- claims diagnoses at 12 months before and after baseline | 42.48 | 78.57 | 40.37 | 80.00 | |||||||
2 positive MINI-MDEs at baseline and at 12 months- claims diagnoses at 12 months before and after baseline | 46.63 | 74.69 | 12.11 | 94.89 | |||||||
Singh (2006) | USA | 40,508 | 1996-1998 | Veterans Integrated Service Network | Self-report of depression | ICD-9: 296.xx, 300.4, 301.1x, 298, 311 | NR | 34.00 | 97.00 | 83.00 | 79.00 |