Global and Public Health

Cosgrove L, Brhlikova P, Lyus R, Herrawi F, D’Ambrozio G, Abi-Jaoude E, Pollock AM, Community Mental Health Journal. 2024 doi: 10.1007/s10597-024-01302-6

Abstract:

Global Burden of Disease (GBD) estimates have significant policy implications nationally and internationally. Disease burden metrics, particularly for depression, have played a critical role in raising governmental awareness of mental health and in calculating the economic cost of depression. Recently, the World Health Organization ranked depression as the single largest contributor to global disability. The main aim of this paper was to assess the basis upon which GBD prevalence estimates for major depressive disorder (MDD) were made. We identify the instruments used in the 2019 GBD estimates and provide a descriptive assessment of the five most frequently used instruments. The majority of country studies, 356/566 (62.9%), used general mental health screeners or structured/semi-structured interview guides, 98/566 (17.3%) of the studies used dedicated depression screeners, and 112 (19.8%) used other tools for assessing depression. Thus, most of the studies used instruments that were not designed to make a diagnosis of depression or assess depression severity. Our results are congruent with and extend previous research that has identified critical flaws in the data underpinning the GBD estimates for MDD. Despite the widespread promotion of these prevalence estimates, caution is needed before using them to inform public policy and mental health interventions. This is particularly important in lower-income countries where resources are scarce. Read more …

Lyus R, Buamah C, Pollock AM, Cosgrove L, Brhlikova P. Journal of the Royal Society of Medicine Open. 2023;14(9). doi:10.1177/20542704231197594

Abstract:

.This study aims to critically appraise the quality of the epidemiological studies underpinning the GBD 2017 estimates for MDD with respect to i) the four GBD 2017 inclusion criteria and ii) the population coverage of the studies by country and WHO region. The WHO’s ranking of depression as the single largest contributor to global disability (20) is being used to advocate for scaling up depression treatment, particularly in the global south where resources are limited. However, GBD 2017 estimates are based on incomplete country and population coverage and unclear methodologies. Extrapolation of single study estimates, the inclusion of studies with non-representative populations, and lack of specific data on MDD, undermines the reliability of many country and regional estimates. The critical flaws in the data underpinning the GBD 2017 estimates mean that policymakers should interpret these with caution. Read more …

Barry, H., Cosgrove, L. Slawson, D (2022), American Family Physician. PMID: 35426634.

Abstract:

Clinical practice guidelines, essential tools for evidence-based practice, have proliferated over the past few decades but remain controversial for several reasons, including discordance among guidelines, the influence of intellectual and financial conflicts of interest, and a lack of adherence to standards for developing trustworthy guidelines. In this editorial, we will use recent hypertension guidelines to illustrate guideline discordance and then propose how to identify trustworthy guidelines. Read more …