Cohort Definition Name : Earliest event of Major depressive disorder, with NO occurrence of certain psychiatric disorder
Contributor name : Dave Kern, Joel Swerdel
Contributor OrcId :
Logic Description : Earliest occurrence of major depressive disorder indexed on diagnosis date requiring no occurrence anytime prior including day 0 of Bipolar disorder, Schizoaffective, Schizophrenia not including paraphrenia, Dementia or Psychotic disorder cohort exit is the end of continuous observation.
Recommended study application : target
Assertion statement : This cohort definition was executed on at least one real person-level observational health data source and resulted in a cohort with at least 1 person.
Target Clinical Description : Depression (major depressive disorder [MDD] or clinical depression) is a common but serious mood disorder. It causes severe symptoms that affect how patients feel, think, and handle daily activities, such as sleeping, eating, or working. An estimated 3.8% of the world’s population is affected by depression, including 5.0% among adults and 5.7% among adults older than 60 years. In the US, MDD affects more than 7% of adults and 13% of adolescents. Risk factors include age, marital status, family history, history of other mental health disorders, chronic illness, social class, and social conditions.
"Evaluation conclusion : We developed a prevalent cohort definition for Major depressive disorder (MDD) using a concept set of 17 concepts which incorporated all those found from the literature review and from the analysis of PHOEBE and orphan concepts in cohort diagnostics. We performed the evaluation across a network of claim data sources and 1 EHR US data source. The data sources are: IBM® MarketScan® Commercial Database (CCAE), Optum’s longitudinal EHR repository (Optum EHR), Optum’s Clinformatics® Data Mart (DOD), IBM® MarketScan® Multi-State Medicaid Database (MDCD), IBM® MarketScan® Medicare Supplemental Database (MDCR), Japan Claims Database (JMDC), Clinical Practice Research Datalink (CPRD) , IQVIA® Australia Longitudinal Patient Data (LPD) database (Australia), IQVIA® Disease Analyzer (DA) France database (France), QVIA® Disease Analyzer (DA) Germany database (Germany), IQVIA® Adjudicated Health Plan Claims Data (formerly PharMetrics Plus) - US database (PharMetrics), IQVIA® Ambulatory EMR (EMR)The algorithm retrieves subjects from all 11 databases tested. We developed a more specific cohort requiring a second diagnosis code for MDD in the time period 31-365 days after index. This cohort improves the specificity of the algorithm albeit at the expense of sensitivity as determined by PheValuator. The significant loss in sensitivity, however, precludes its use.
Performance characteristics were determined for 10 of the 11 databases. The remaining database did not contain enough subjects to produce an accurate diagnostic model. Using one code, sensitivity ranged from about 47% to about 91% in JMDC while positive predictive value ranged from about 73% in Pharmetrics to about 90% in Germany. Using two codes, sensitivity decreased, ranging from about 9% to about 68% in JMDC while positive predictive value increased, ranging from 90% in Pharmetrics to about 99% in Germany.