The National Population Health Survey's assessment of depression risk factor associations: a simulation study assessing vulnerability to bias

In Canada, the major source of longitudinal information on major depression epidemiology has been the National Population Health Survey (NPHS). However, the timing of NPHS interviews may raise concerns about the quality of its estimates. Specifically, the NPHS interview assesses major depressive episodes (MDE) in the year before an interview, whereas the interviews are conducted 2 years apart. The objective of this study was to determine whether this aspect of the NPHS can be expected to introduce bias into longitudinal estimates of risk factor associations.

A simulation model was used to represent the underlying epidemiology and the expected results of a study adopting the NPHS approach to assessment of MDE. The model was used to explore the extent of the resulting distortion of estimates across a range of underlying hazard ratios.

The simulations indicated that the timing and coverage of depression interviews in the NPHS would not introduce substantial bias. The model suggested that incidence would be underestimated as a result of episodes being missed, but that this would not substantially distort estimates of association.

The timing of interviews in the NPHS is not expected to cause biased relative risk estimates. NPHS estimates may, of course, be influenced by other sources of bias.