VARIATION IN CONCEPTUAL AND OPERATIONAL DEFINITIONS OF DEPRESSION IN REAL-WORLD RESEARCH
Author(s)
Jared H. Kamauu1, Michael Buck, PhD2, Craig G Parker, MD, MS3, Allise Kamauu, MS4, Scott L. DuVall, PhD5, Aaron Kamauu, MPH, MS, MD4.
1Content Engineer, Navidence, Inc., Lehi, UT, USA, 2Navidence, Inc., Aurora, CO, USA, 3Navidence, Inc., Sandy, UT, USA, 4Navidence, Inc., Bountiful, UT, USA, 5PurpleLab, Wayne, PA, USA.
1Content Engineer, Navidence, Inc., Lehi, UT, USA, 2Navidence, Inc., Aurora, CO, USA, 3Navidence, Inc., Sandy, UT, USA, 4Navidence, Inc., Bountiful, UT, USA, 5PurpleLab, Wayne, PA, USA.
OBJECTIVES: Conceptual and computable operational definitions (CODefs) are integral to Real-World Research (RWR), especially to define cohort phenotypes. Interpretation of results in RWR are directly dependent on the CODefs used. However, variance in CODefs can create inconsistencies in research results and interpretation. This analysis demonstrates variations in cohort-defining CODefs from reputable sources and publications on patients with depression.
METHODS: We reviewed definitions for depression, major depressive disorder (MDD), and treatment resistant depression (TRD) that were published in literature and clinical references (i.e. NICE). Those definitions were extracted and compared against each other to see the level of variation between the references. The analysis includes comparison of code lists (ICD-10-CM), scoring models, and treatment failure.
RESULTS: 24 references were reviewed and 33 distinct CODefs were extracted as definitions of depression, MDD, or TRD. The most common definition was Diagnostic and Statistical Manual of Mental Disorders (DSM-5) criteria which appeared in 8 of the references. After that were two diagnosis code lists, one defining depression (3/24) and the other MDD (3/24), and the initiation of a third antidepressant defining TRD (3/24). 20 definitions only appeared in a single reference.13 TRD definitions across 8 references showed variance in the number of treatments and their definition for failure of treatment. 10 references published 7 distinct code list definitions for depression/MDD. Every code list included F32 and F33 codes, but differed by the additional codes that were included or excluded. The most unique definition came from the depression deficit component of the Veterans Affairs Frailty Index (VA-FI) which included disorders related to depression such as bipolar disorder.
CONCLUSIONS: This review showcases a large amount of variety in definitions for depression. This variance creates difficulty in consistent interpretation of results. Awareness of this variance in definitions is essential to understanding the impact on RWR studies.
METHODS: We reviewed definitions for depression, major depressive disorder (MDD), and treatment resistant depression (TRD) that were published in literature and clinical references (i.e. NICE). Those definitions were extracted and compared against each other to see the level of variation between the references. The analysis includes comparison of code lists (ICD-10-CM), scoring models, and treatment failure.
RESULTS: 24 references were reviewed and 33 distinct CODefs were extracted as definitions of depression, MDD, or TRD. The most common definition was Diagnostic and Statistical Manual of Mental Disorders (DSM-5) criteria which appeared in 8 of the references. After that were two diagnosis code lists, one defining depression (3/24) and the other MDD (3/24), and the initiation of a third antidepressant defining TRD (3/24). 20 definitions only appeared in a single reference.13 TRD definitions across 8 references showed variance in the number of treatments and their definition for failure of treatment. 10 references published 7 distinct code list definitions for depression/MDD. Every code list included F32 and F33 codes, but differed by the additional codes that were included or excluded. The most unique definition came from the depression deficit component of the Veterans Affairs Frailty Index (VA-FI) which included disorders related to depression such as bipolar disorder.
CONCLUSIONS: This review showcases a large amount of variety in definitions for depression. This variance creates difficulty in consistent interpretation of results. Awareness of this variance in definitions is essential to understanding the impact on RWR studies.
Conference/Value in Health Info
2026-11, ISPOR Europe 2026, Vienna, Austria
Value in Health, Volume 29, Issue 12S
Code
MSR12
Topic
Methodological & Statistical Research
Topic Subcategory
Artificial Intelligence, Machine Learning, Predictive Analytics, Confounding, Selection Bias Correction, Causal Inference
Disease
Mental Health (including addiction)