Has ‘lifetime prevalence’ reached the end of its life? An examination of the concept
Open accessAbstract
Many cross‐sectional surveys in psychiatric epidemiology report estimates of lifetime prevalence, and the results consistently show a declining trend with age for such disorders as depression and anxiety. In a closed cohort with no mortality, lifetime prevalence should increase or remain constant with age. For mortality to account for declining lifetime prevalence, mortality rates in those with a disorder must exceed those without a disorder by a sufficient extent that more cases would be removed from the prevalence pool than are added by new cases, and this is unlikely to occur across most of the age range. We argue that the decline in lifetime prevalence with age cannot be explained by period or cohort effects or be due to a survivor effect, and are likely due to a variety of other factors, such as study design, forgetting, or reframing. Further, because lifetime prevalence is insensitive to changes in treatment effectiveness or demand for services, it is a parameter that should be dropped from the lexicon of psychiatric epidemiology. Copyright © 2009 John Wiley & Sons, Ltd.
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The prevalence of PTSD obtained in the prior retrospective meta-analysis may be an underestimate due to retrospective reporting biases.
“One potential explanation for this unexpected finding is that the prevalence of PTSD obtained in the prior meta-analysis may be an underestimate due to retrospective reporting biases (e.g., recall failure).”
From PTSD in the Year Following Sexual Assault: A Meta-Analysis of Prospective Studies (2023) · cites this paper as Streiner et al., 2009
The “Forgetting” section (page not available) says recall bias can cause respondents to forget past psychiatric episodes and thereby lower reported lifetime prevalence. It discusses anxiety and depression, however, not PTSD or the prior meta-analysis, so it supports the proposed mechanism but not its specific application here. (LLM, conf=0.82)
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“Indeed, lifetime prevalence estimates have been critiqued (Streiner et al., 2009), and one study found that the prevalence of common mental disorders obtained from prospective studies was double the prevalence obtained from retrospective studies (Moffitt et al.”
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Self-citationRecall of recent and more remote depressive episodes in a prospective cohort study
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- Authors
- Streiner, D. L., Patten, S. B., Anthony, J. C., & Cairney, J.
- Affiliations
- University of Toronto (CA)
- University of Calgary (CA)
- Michigan State University (US)
- McMaster University (CA)
- Corresponding author
- Streiner, David L.
- Venue
- International Journal of Methods in Psychiatric Research
- Publisher
- Wiley
- Published
- 2009-12
- Volume
- 18
- Issue
- 4
- Pages
- 221-228
- ISSN
- 1049-8931 (ISSN-L)
- 1557-0657
- PMC
- PMC4906789
- OpenAlex
- W2025501801
- Cited by
- 69
- References
- 6
- Citations by year
- 2026: 2 · 2025: 2 · 2024: 5 · 2023: 4 · 2022: 6 · 2021: 6 · 2020: 5 · 2019: 2 · 2018: 2 · 2017: 2 · 2016: 10 · 2015: 2 · 2014: 7 · 2013: 7 · 2012: 3
- FWCI
- 3.05
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- International Journal of Methods in Psychiatric Research (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institute on Drug Abuse (K05DA015799, R01DA016558)
- Topics
- Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
- Physical Sciences › Mathematics › Statistics and Probability › Statistical Methods in Epidemiology
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Mental Health Research Topics
- Keywords
- lifetime prevalence, depression, anxiety, mortality, cohort effects, period effects, forgetting, reframing, treatment effectiveness, psychiatric epidemiology
- MeSH terms
- Age Factors, Mental Disorders, Humans, Mortality, Psychiatric Status Rating Scales, Self Concept, Cohort Studies, Effect Modifier, Epidemiologic, Incidence, Prevalence
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