Development and validation of a prediction score to assess the risk of depression in primary care

Abstract

Background: Major depression is the most frequent psychiatric disorder and primary care is a crucial setting for its early recognition. This study aimed to develop and validate the DEP-HScore as a tool to predict depression risk in primary care and increase awareness and investigation of this condition among General Practitioners (GPs).

Methods: The DEP-HScore was developed using data from the Italian Health Search Database (HSD). A cohort of 903,748 patients aged 18 years or older was selected and followed until the occurrence of depression, death or end of data availability (December 2019). Demographics, somatic signs/symptoms and psychiatric/medical comorbidities were entered in a multivariate Cox regression to predict the occurrence of depression. The coefficients formed the DEP-HScore for individual patients. Explained variance (pseudo-R²), discrimination (AUC) and calibration (slope estimating predicted-observed risk relationship) assessed the prediction accuracy.

Results: The DEP-HScore explained 18.1 % of the variation in occurrence of depression and the discrimination value was equal to 67 %. With an event horizon of three months, the slope and intercept were not significantly different from the ideal calibration.

Limitations: The DEP-HScore has not been tested in other settings. Furthermore, the model was characterized by limited calibration performance when the risk of depression was estimated at the 1-year follow-up.

Conclusions: The DEP-HScore is reliable tool that could be implemented in primary care settings to evaluate the risk of depression, thus enabling prompt and suitable investigations to verify the presence of this condition.

Keywords: Depression; General practitioner; Prediction model; Primary healthcare; Score.