Presentation (CTI)

OBJECTIVES: To identify characteristics associated with severe health utility impairment and evaluate the performance of a parsimonious prediction model among adults reporting past-year depression in the EU5.
METHODS: Data were from the 2025 European National Health and Wellness Survey. Adults reporting depression during the previous 12 months were included. Severe health utility impairment was defined as an EQ-5D-5L EU index score in the lowest quartile of the study sample (<=0.508). Multivariable logistic regression evaluated clinically available predictors. Model performance was assessed using the area under the receiver operating characteristic curve (AUC), 10-fold cross-validation, Brier score, and Hosmer-Lemeshow calibration test. Discrimination was compared with a PHQ-9-only model.
RESULTS: Among 386 adults reporting depression, 96 (24.9%) met criteria for severe utility impairment. The final complete-case model included 366 respondents, including 90 events. Higher depressive symptom severity (PHQ-9; OR=1.21 per point; 95% CI, 1.14-1.28; p<0.0001), higher body mass index (OR=1.09; 95% CI, 1.05-1.14; p<0.0001), anxiety (OR=2.10; 95% CI, 1.07-4.14; p=0.031), and antidepressant use (OR=2.41; 95% CI, 1.35-4.31; p=0.003) were independently associated with severe utility impairment. The final model showed good apparent discrimination (AUC=0.839; 95% CI, 0.791-0.887), with stable performance in 10-fold cross-validation (AUC=0.822; 95% CI, 0.772-0.873). Discrimination exceeded the PHQ-9-only model (AUC=0.794; 95% CI, 0.743-0.846; difference=0.045; p=0.013). Calibration was acceptable (Hosmer-Lemeshow p=0.491; Brier score=0.128).
CONCLUSIONS: A parsimonious model using PHQ-9, body mass index, anxiety, and antidepressant use identified severe utility impairment with good internally validated discrimination. These findings support feasible risk stratification among adults reporting depression.