Validation of case definitions of depression derived from administrative data against the CIDI-SF as reference standard: results from the PROspective Québec (PROQ) study.

BACKGROUND: Administrative data have several advantages over questionnaire and interview data to identify cases of depression: they are usually inexpensive, available for a long period of time and are less subject to recall bias and differential classification errors. However, the validity of administrative data in the correct identification of depression has not yet been studied in general populations. The present study aimed to 1) evaluate the sensitivity and specificity of administrative cases of depression using the validated Composite International Diagnostic Interview - Short Form (CIDI-SF) as reference standard and 2) compare the known-groups validity between administrative and CIDI-SF cases of depression. METHODS: The 5487 participants seen at the last wave (2015-2018) of the PROQ cohort had CIDI-SF questionnaire data linked to hospitalization and medical reimbursement data provided by the provincial universal healthcare provider and coded using the International Classification of Disease. We analyzed the sensitivity and specificity of several case definitions of depression from this administrative data. Their association with known predictors of depression was estimated using robust Poisson regression models. RESULTS: Administrative cases of depression showed high specificity (≥ 96%), low sensitivity (19-32%), and rather low agreement (Cohen's kappa of 0.21-0.25) compared with the CIDI-SF. These results were consistent over strata of sex, age and education level and with varying case definitions. In known-groups analysis, the administrative cases of depression were comparable to that of CIDI-SF cases (RR for sex: 1.80 vs 2.03 respectively, age: 1.53 vs 1.40, education: 1.52 vs 1.28, psychological distress: 2.21 vs 2.65). CONCLUSION: The results obtained in this large sample of a general population suggest that the dimensions of depression captured by administrative data and by the CIDI-SF are partially distinct. However, their known-groups validity in relation to risk factors for depression was similar to that of CIDI-SF cases. We suggest that neither of these data sources is superior to the other in the context of large epidemiological studies aiming to identify and quantify risk factors for depression.

Socioeconomic inequalities, psychosocial stressors at work and physician-diagnosed depression: Time-to-event mediation analysis in the presence of time-varying confounders.

OBJECTIVES: There is evidence that both low socioeconomic status (SES) and psychosocial stressors at work (PSW) increase risk of depression, but prospective studies on the contribution of PSW to the socioeconomic gradient of depression are still limited. METHODS: Using a prospective cohort of Quebec white-collar workers (n = 9188 participants, 50% women), we estimated randomized interventional analogues of the natural direct effect of SES indicators at baseline (education level, household income, occupation type and a combined measure) and of their natural indirect effects mediated through PSW (job strain and effort-reward imbalance (ERI) measured at the follow-up in 1999-2001) on incident physician-diagnosed depression. RESULTS: During 3 years of follow-up, we identified 469 new cases (women: 33.1 per 1000 person-years; men: 16.8). Mainly in men, low SES was a risk factor for depression [education: hazard ratio 1.72 (1.08-2.73); family income: 1.67 (1.04-2.67); occupational type: 2.13 (1.08-4.19)]. In the entire population, exposure to psychosocial stressors at work was associated with increased risk of depression [job strain: 1.42 (1.14-1.78); effort-reward imbalance (ERI) 1.73 (1.41-2.12)]. The estimated indirect effects of socioeconomic indicators on depression mediated through job strain ranged from 1.01 (0.99-1.03) to 1.04 (0.98-1.10), 4-15% of total effects, and for low reward from 1.02 (1.00-1.03) to 1.06 (1.01-1.11), 10-15% of total effects. DISCUSSION: Our study suggests that PSW only slightly mediate the socioeconomic gradient of depression, but that socioeconomic inequalities, especially among men, and PSW both increase the incidence of depression.

Psychosocial Stressors at Work and the Risk of Sickness Absence Due to a Diagnosed Mental Disorder: A Systematic Review and Meta-analysis.

Importance: Mental health problems are associated with considerable occupational, medical, social, and economic burdens. Psychosocial stressors at work have been associated with a higher risk of mental disorders, but the risk of sickness absence due to a diagnosed mental disorder, indicating a more severe condition, has never been investigated in a systematic review and meta-analysis. Objective: To synthesize the evidence of the association of psychosocial stressors at work with sickness absence due to a diagnosed mental disorder among adult workers. Data Sources: Seven electronic databases (MEDLINE, Embase, PsycInfo, Web of Science, CINAHL, Sociological Abstracts, and International Bibliography of the Social Sciences), 3 gray literature databases (Grey Literature Report, WHO-IRIS and Open Grey), and the reference lists of all eligible studies and reviews were searched in January 2017 and updated in February 2019. Study Selection: Only original prospective studies evaluating the association of at least 1 psychosocial stressor at work from the 3 most recognized theoretical models were eligible: the job demand-control-support model, including exposure to job strain (high psychological demands with low job control); effort-reward imbalance model; and organizational justice model. Study selection was performed in duplicate by blinded independent reviewers. Among the 28 467 citations screened, 23 studies were eligible for systematic review. Data Extraction and Synthesis: This meta-analysis followed the PRISMA and MOOSE guidelines. Data extraction and risk of bias evaluation, using the Risk of Bias in Nonrandomized Studies-Interventions tool, were performed in duplicate by blinded independent reviewers. Data were pooled using random-effect models. Main Outcomes and Measures: Sickness absence due to a mental disorder with a diagnosis obtained objectively. Results: A total of 13 studies representing 130 056 participants were included in the 6 meta-analyses. Workers exposed to low reward were associated with a higher risk of sickness absence due to a diagnosed mental disorder compared with nonexposed workers (pooled risk ratio [RR], 1.76 [95% CI, 1.49-2.08]), as were those exposed to effort-reward imbalance (pooled RR, 1.66 [95% CI, 1.37-2.00]), job strain (pooled RR, 1.47 [95% CI, 1.24-1.74]), low job control (pooled RR, 1.25 [95% CI, 1.02-1.53]), and high psychological demands (pooled RR, 1.23 [95% CI, 1.04-1.45]). Conclusions and Relevance: This meta-analysis found that workers exposed to psychosocial stressors at work were associated with a higher risk of sickness absence due to a mental disorder. A better understanding of the importance of these stressors could help physicians when evaluating their patients' mental health and work capacity.

Job strain and binge eating among Brazilian workers participating in the ELSA-Brasil study: does BMI matter?

OBJECTIVE: To assess the association between job strain and binge eating as well as the effect-modifying influence of body mass index (BMI) on this association. METHODS: A total of 11,951 active civil servants from the multicenter Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) was included in this cross-sectional analysis. Job strain was assessed using the Demand-Control-Support Questionnaire. Binge eating was defined as eating a large amount of food with a sense of lack of control over what and how much is eaten in less than 2 hours at least twice a week. Multiple logistic regression was used to determine the association between binge eating and job strain as well as its interaction with BMI. RESULTS: After adjustment, and using low-strain job as the reference category, binge eating was associated with high-strain job (high demand/low control: odds ratio [OR]=1.58, 95% confidence interval [CI] 1.26-1.98), active job (high demand/high control: OR=1.35, 95% CI 1.07-1.70), and passive job (low demand/low control: OR=1.24, 95% CI 1.01-1.53). Psychological job demands were positively associated with binge eating (OR=1.04, 95% CI 1.01-1.07), while greater job control and social support at work were each inversely associated with binge eating (OR=0.95, 95% CI 0.92-0.97 and OR=0.96, 95% CI 0.94-0.98, respectively). BMI modified the association between job strain and binge eating: Heavier psychological job demands were associated with higher odds of binge eating among obese participants, while a stronger inverse association between job control and binge eating was seen among slimmer participants. CONCLUSIONS: Job strain increases the odds of binge eating and this association is modified by BMI.