A prediction algorithm for first onset of major depression in the general population: development and validation

J Epidemiol Community Health. 2014 May;68(5):418-24. doi: 10.1136/jech-2013-202845. Epub 2014 Jan 3.


Objective: Prediction algorithms are useful for making clinical decisions and for population health planning. However, such prediction algorithms for first onset of major depression do not exist. The objective of this study was to develop and validate a prediction algorithm for first onset of major depression in the general population.

Methods: Longitudinal study design with approximate 3-year follow-up. The study was based on data from a nationally representative sample of the US general population. A total of 28 059 individuals who participated in Waves 1 and 2 of the US National Epidemiologic Survey on Alcohol and Related Conditions and who had not had major depression at Wave 1 were included. The prediction algorithm was developed using logistic regression modelling in 21 813 participants from three census regions. The algorithm was validated in participants from the 4th census region (n=6246). Major depression occurred since Wave 1 of the National Epidemiologic Survey on Alcohol and Related Conditions, assessed by the Alcohol Use Disorder and Associated Disabilities Interview Schedule-diagnostic and statistical manual for mental disorders IV.

Results: A prediction algorithm containing 17 unique risk factors was developed. The algorithm had good discriminative power (C statistics=0.7538, 95% CI 0.7378 to 0.7699) and excellent calibration (F-adjusted test=1.00, p=0.448) with the weighted data. In the validation sample, the algorithm had a C statistic of 0.7259 and excellent calibration (Hosmer-Lemeshow χ(2)=3.41, p=0.906).

Conclusions: The developed prediction algorithm has good discrimination and calibration capacity. It can be used by clinicians, mental health policy-makers and service planners and the general public to predict future risk of having major depression. The application of the algorithm may lead to increased personalisation of treatment, better clinical decisions and more optimal mental health service planning.

Keywords: Depression; Longitudinal Studies; Mental Health; Prevention; Public Health Policy.

Publication types

  • Research Support, Non-U.S. Gov't
  • Validation Study

MeSH terms

  • Adult
  • Age of Onset
  • Alcoholism / diagnosis
  • Alcoholism / epidemiology*
  • Alcoholism / psychology
  • Algorithms*
  • Calibration
  • Depressive Disorder, Major / diagnosis
  • Depressive Disorder, Major / epidemiology*
  • Diagnostic and Statistical Manual of Mental Disorders
  • Female
  • Follow-Up Studies
  • Humans
  • Longitudinal Studies
  • Male
  • Population Surveillance
  • Regression Analysis
  • Reproducibility of Results
  • United States