RETRACTED – Mental health in UK Biobank: development, implementation and results from an online questionnaire completed by 157 366 participants

Abstract

BackgroundUK Biobank is a well-characterised cohort of over 500 000 participants that offers unique opportunities to investigate multiple diseases and risk factors.AimsAn online mental health questionnaire completed by UK Biobank participants was expected to expand the potential for research into mental disorders.MethodAn expert working group designed the questionnaire, using established measures where possible, and consulting with a patient group regarding acceptability. Case definitions were defined using operational criteria for lifetime depression, mania, anxiety disorder, psychotic-like experiences and self-harm, as well as current post-traumatic stress and alcohol use disorders.Results157 366 completed online questionnaires were available by August 2017. Comparison of self-reported diagnosed mental disorder with a contemporary study shows a similar prevalence, despite respondents being of higher average socioeconomic status than the general population across a range of indicators. Thirty-five per cent (55 750) of participants had at least one defined syndrome, of which lifetime depression was the most common at 24% (37 434). There was extensive comorbidity among the syndromes. Mental disorders were associated with high neuroticism score, adverse life events and long-term illness; addiction and bipolar affective disorder in particular were associated with measures of deprivation.ConclusionsThe questionnaire represents a very large mental health survey in itself, and the results presented here show high face validity, although caution is needed owing to selection bias. Built into UK Biobank, these data intersect with other health data to offer unparalleled potential for crosscutting biomedical research involving mental health.Declaration of interestG.B. received grants from the National Institute for Health Research during the study; and support from Illumina Ltd. and the European Commission outside the submitted work. B.C. received grants from the Scottish Executive Chief Scientist Office and from The Dr Mortimer and Theresa Sackler Foundation during the study. C.S. received grants from the Medical Research Council and Wellcome Trust during the study, and is the Chief Scientist for UK Biobank. M.H. received grants from the Innovative Medicines Initiative via the RADAR-CNS programme and personal fees as an expert witness outside the submitted work.

Indicators of mental disorders in UK Biobank—A comparison of approaches

“…The higher levels of diagnosis of a psychosis diagnosis may be partly because the registry used in the Finnish study goes back further in time but may also be related to participation bias. The Finnish study was a modest size study aiming at representativeness, with a participation rate of 93% of those selected, whereas UKB followed a different model, requesting volunteers from the community (Davis, Coleman, et al, ; Fry et al, ): People with an enduring psychotic disorder may have been less willing and/or able to volunteer.…”

“…Moreover, these episodes may have happened many decades ago, before 1997 when the data for England start. Most mentions of mental disorder will therefore be secondary diagnoses in participants admitted to hospital with other problems, which have not been specifically validated (Davis, Coleman, et al, ). In this study, the low numbers identified in hospital data linkage, with high levels of lifetime symptom‐based outcomes in those individuals, suggest a specific but insensitive measure.…”

“…The MHQ had a very good response rate compared with previous UKB online questionnaires, and it gives an unparalleled sample size for a mental health survey. However, like much observational research, it is subject to participation bias in its volunteers (Davis, Coleman, et al, ; Fry et al, ). Given that participation in research can be patterned by mental health (Atherton, Fuller, Shepherd, Strachan, & Power, ; Knudsen, Hotopf, Skogen, Øverland, & Mykletun, ), it may be that people with severe symptoms of mental disorder were less likely to volunteer or complete the MHQ, as might be suggested by the small number of people with a hospital data‐linkage diagnosis of a psychotic disorder, which may limit generalisability of our findings to other settings.…”

“…Mental disorder in this context might be both an outcome and a risk factor for other health outcomes. The consortium has focussed on two aspects: validating administrative secondary care diagnostic codes (Davis, Coleman, et al, 2018;Davis, Sudlow, & Hotopf, 2016) and designing an online Mental Health Questionnaire (MHQ) to identify symptom-based outcomes (Davis, Bashford, et al, 2018). Some of the outcomes in the MHQ are based on diagnostic interviews and are analogous to mental disorder diagnoses (e.g., depression and generalised anxiety disorder).…”

“…Others assess other aspects of mental health such as psychotic experiences (PEs) and self-harm. Results of the UKB MHQ are available for 157,366 participants, representing 31% of the original UKB sample (Davis, Coleman, et al, 2018).…”