ECHIM Final Report

23. DEPRESSION
Definition: Proportion of persons who have had episode(s) of major depression during the
past 12 months. Major depression is a mental disorder characterised by sustained depression
of mood, anhedonia, sleep and appetite disturbances, and feelings of worthlessness, guilt,
and hopelessness.
Calculation:
1) Proportion of individuals reporting to have been diagnosed with chronic depression which
occurred during the past 12 months, per 100 000 survey population, derived from EHIS
questions HS.4/5/6: HS.4: Do you have or have you ever had any of the following diseases
or conditions (19. Chronic depression) (yes / no). If yes: HS.5: Was this disease/condition
diagnosed by a medical doctor (yes / no). HS.6: Have you had this disease/condition in the
past 12 months (yes / no).
2) Recommendation by Mindful/Working Party Mental Health: Age and sex adjusted
prevalence of cases fulfilling the criteria of major depression for at least two weeks during
past 12 months. Instrument to be used is The World Health Organisation Composite
International Diagnostic Interview Short Form, CIDI-SF. Diagnostic criteria for a major
depressive episode (MD; DSM-IV) include a depressed mood, a marked reduction of
interest or pleasure in virtually all activities, or both, lasting for at least 2 weeks. In addition,
the following 7 further questions are asked: losing interest, feeling tired, change in weight,
difficulty sleeping, trouble concentrating, feeling down, and thoughts about death (present
and lasting for at least 2 weeks). The respondent’s score is then calculated as the sum of
positive responses to these additional seven questions (range 0–7). The cut-off point for a
major depressive episode is 3, in the range of 0 to 7.
3) EPIC Elderly NAH recommendation: Self-perceived depression for people 60+ years of
age. Calculated as the number of persons who reported major depression divided by total
target population x 100.
ECHIM prefers 1.
Notes: The World Health Organisation Composite International Diagnostic Interview,
CIDI, is a comprehensive psychiatric diagnostic interview designed to be used by trained
nonclinician interviewers to diagnose more than 40 mental disorders among adults
from different cultures according to the definitions and criteria of both ICD-10 and the
Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV) diagnostic
systems. The cut-point chosen for major depression depends on the aim of the study, in
general population studies cut-point usually is between 3 and to 5.
CIDI-SF is preferred to CIDI, because CIDI-SF takes much shorter time to administer.
CIDI-SF is also reported to give 93% accuracy for depression compared with the full CIDI.
CIDI is not in wide use, no comparable data for variant 2 exist at the moment.
Self-perceived depression is liable to be affected by individual, social and cultural
expectations.
24. AMI
Definition:
1) Incidence/attack rate of acute myocardial infarction or coronary death in the population.
2) Mortality from ischaemic heart disease in the population
3) Prevalence of past AMI in the population
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