Missed Opportunities for Depression Screening and Treatment in the United States

Elisabeth Kato; Amanda E. Borsky; Samuel H. Zuvekas; Anita Soni; Quyen Ngo-Metzger

doi:10.3122/jabfm.2018.03.170406

Article Figures & Data

Tables

View popup

Table 1.

Percent of Civilian Noninstitutionalized Population Assessed for Depression by Selected Sociodemographic Characteristics, 2014/2015 (n = 1852)

	Unweighted (N)	Weighted proportion (%)	Weighted percent (95% confidence intervals)	P value
Overall	1852	100.0	48.6 (45.5–51.6)
Sex				<.001
Male	841	47.4	42.5 (38.5–46.5)
Female	1011	52.6	54.0 (50.1–58.0)
Age (years)				<.001
35 to 49	312	35.0	40.2 (34.3–46.0)
50 to 64	604	36.7	52.9 (48.5–57.3)
65 to 74	631	16.1	57.5 (52.7–62.4)
75+	305	12.1	47.9 (41.7–54.0)
Race/Ethnicity				<.001
Hispanic	199	12.4	31.3 (23.6–39.0)
Non-Hispanic White/Other	1368	72.6	54.4 (51.1–57.7)
Non-Hispanic Black	199	10.3	38.1 (28.7–47.4)
Non-Hispanic Asian	86	4.7	27.7 (16.4–38.9)
Education				.021
Less than high school diploma	250	13.0	42.2 (34.7–49.8)
High school diploma	510	27.3	44.2 (39.0–49.4)
Some college	535	29.2	49.2 (44.5–53.9)
Bachelor's degree	307	17.4	55.8 (49.4–62.2)
Master's degree+	250	13.1	52.8 (45.3–60.3)
Poverty status				.182
<100% of FPL (poor)	224	13.0	55.3 (46.7–63.8)
100% to 124% of FPL (near poor)	93	4.5	40.1 (27.6–52.6)
125% to 199% of FPL (low income)	257	14.1	42.4 (34.8–50.1)
200% to 399% of FPL (middle income)	521	29.1	48.2 (43.0–53.4)
>400% of FPL (high income)	757	39.3	49.8 (45.5–54.1)
Region				.012
Northeast	310	18.2	54.6 (47.8–61.4)
Midwest	421	21.6	51.8 (45.2–58.4)
South	702	38.0	47.0 (41.8–52.2)
West	419	22.2	43.2 (36.9–49.5)
Metropolitan statistical area status				.840
Non-metropolitan statistical area	321	15.6	47.7 (39.1–56.4)
Metropolitan statistical area	1531	84.4	48.7 (45.5–51.9)
Perceived health				<.001
Excellent	380	20.1	36.0 (30.5–41.6)
Very good	600	33.6	46.2 (41.2–51.2)
Good	578	30.9	50.7 (45.4–56.0)
Fair/Poor	294	15.4	65.8 (59.4–72.1)
Insurance coverage^{^†}				<.001
Any Private	1187	67.7	49.8 (46.3–53.4)
Public only	546	22.0	56.8 (51.3–62.2)
Uninsured	119	10.2	22.5 (14.1–30.8)

Source: Medical Expenditure Panel Survey, 2014 to 2015.⁹
↵† The definitions for the insurance variables are the following: any private (person had any private insurance coverage, including TRICARE/CHAMPVA, any time during 2014), public only (person had only public insurance coverage during 2014), and uninsured (person was uninsured during all of 2014).
FPL, federal poverty level.

View popup

Table 2.

Civilian Non-Institutionalized Population Depression Assessment Rates by Depressive Symptom Status, 2014/2015 (n = 1852)

	PHQ2 ≥3 (n = 132)^*	PHQ2 <3 (n = 1720)^*	Difference
	Weighted percent (95% confidence intervals)	Weighted percent (95% confidence intervals)	P value
% of population	7.4 (6.1%–8.9%)	92.6 (91.1–93.9)
% screened	66.4 (56.6–76.2%)	40.4 (37.5–43.2)	<.001
% any mental health treatment	65.5 (55.8–75.2%)	19.4 (17.0–21.8)	<.001
% screened and/or treated	76.5 (67.9–85.1%)	46.3 (43.2–49.5)	<.001

Source: Medical Expenditure Panel Survey, 2014 to 2015.⁹
↵* The PHQ2 is the two-item Patient Health Questionnaire (PHQ-2), which is a validated measure of depressive symptoms and accepted clinical screening tool for depression.^7,13,14

View popup

Table 3.

Civilian Noninstitutionalized Population Multivariable Logistic Regression of Health and Sociodemographic Characteristics Associated with Depression Assessment in the United States, 2014/2015 (n = 1852)

	Odds ratio (95% confidence interval)	P value
Sex
Male	0.58 (0.46–0.72)	<.001
Female (reference)
Age (years)
35 to 49	0.81 (0.60–1.09)	.156
50 to 64 (reference)
65 to 74	0.83 (0.62–1.10)	.200
75+	0.47 (0.32–0.69)	<.001
Race/Ethnicity
Hispanic	0.47 (0.29–0.75)	.002
Non-Hispanic White/other (reference)
Non-Hispanic Black	0.42 (0.27–0.67)	<.001
Non-Hispanic Asian	0.35 (0.19–0.67)	.002
Education
Less than high school diploma	0.59 (0.36–0.95)	.032
High school diploma	0.52 (0.35–0.75)	.001
Some college	0.72 (0.49–1.07)	.101
Bachelor's degree	1.13 (0.76–1.68)	.539
Master's degree+ (reference)
Poverty status
<100% of FPL (poor)	1.42 (0.93–2.19)	.108
100% to 124% of FPL (near poor)	0.79 (0.42–1.51)	.475
125% to 199% of FPL (low income)	0.92 (0.58–1.44)	.703
200% to 399% of FPL (middle income)	1.11 (0.84–1.47)	.450
>400% of FPL (high income) (reference)
Region
Northeast (reference)
Midwest	0.90 (0.61–1.34)	.609
South	0.87 (0.62–1.23)	.432
West	0.76 (0.51–1.12)	.165
MSA Status
Non-metropolitan statistical area	0.82 (0.56–1.21)	.316
Metropolitan statistical area (reference)
Perceived health
Excellent	0.37 (0.23–0.58)	<.001
Very good	0.51 (0.33–0.78)	.002
Good	0.62 (0.43–0.91)	.015
Fair/poor (reference)
Insurance coverage
Any private (reference)
Public only	1.20 (0.86–1.68)	.276
Uninsured	0.30 (0.18–0.51)	<.001
PHQ2 ≥3
No	0.39 (0.24–0.63)	<.001
Yes (reference)
No. of chronic conditions	1.27 (1.17–1.38)	<.001
Constant	8.25 (4.23–16.07)	<.001

Source: Medical Expenditure Panel Survey, 2014 to 2015.⁹
FPL, federal poverty level; MSA, Metropolitan Statistical Area; PHQ2, Patient Health Questionnaire.