European Journal of Epidemiology

, Volume 20, Issue 1, pp 103–111 | Cite as

Lifetime prevalence estimates of major depression: An indirect estimation method and a quantification of recall bias

  • Michelle Elisabeth KruijshaarEmail author
  • Jan Barendregt
  • Theo Vos
  • Ron de Graaf
  • Jan Spijker
  • Gavin Andrews
Psychiatric Epidemiology


The measurement of lifetime prevalence of depression in cross-sectional surveys is biased by recall problems. We estimated it indirectly for two countries using modelling, and quantified the underestimation in the empirical estimate for one. A microsimulation model was used to generate population-based epidemiological measures of depression. We fitted the model to 1-and 12-month prevalence data from the Netherlands Mental Health Survey and Incidence Study (NEMESIS) and the Australian Adult Mental Health and Wellbeing Survey. The lowest proportion of cases ever having an episode in their life is 30% of men and 40% of women, for both countries. This corresponds to a lifetime prevalence of 20 and 30%, respectively, in a cross-sectional setting (aged 15–65). The NEMESIS data were 38% lower than these estimates. We conclude that modelling enabled us to estimate lifetime prevalence of depression indirectly. This method is useful in the absence of direct measurement, but also showed that direct estimates are underestimated by recall bias and by the cross-sectional setting.


Major Depression Models (theoretical) Prevalence Unipolar Depression 



The Netherlands Mental Health Survey and Incidence Study


Major Depression


The Composite International Diagnostic Interview


The Diagnostic and


The International Classification of Diseases


Relative Risk

95% CI

95% Confidence Interval


Epidemiologic Catchment Area


National Comorbidity Survey


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Copyright information

© Springer 2005

Authors and Affiliations

  • Michelle Elisabeth Kruijshaar
    • 1
    • 2
    Email author
  • Jan Barendregt
    • 1
  • Theo Vos
    • 3
    • 6
  • Ron de Graaf
    • 4
  • Jan Spijker
    • 4
  • Gavin Andrews
    • 5
  1. 1.Department of Public Health, Erasmus Medical CenterUniversity Hospital RotterdamRotterdamthe Netherlands
  2. 2.Department for Public Health ForecastingNational Institute of Public Health and the EnvironmentBilthoventhe Netherlands
  3. 3.Department of Human ServicesHealth Surveillance and Evaluation SectionVictoriaAustralia
  4. 4.Netherlands Institute of Mental Health and AddictionUtrechtthe Netherlands
  5. 5.Clinical Research Unit on Anxiety and DepressionUniversity of New South WalesSydneyAustralia
  6. 6.School of Population HealthUniversity of QueenslandBrisbaneAustralia

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