Background
Methods
Data source and cohort selection
Measures
Mental health treatment for depression
Statistical analysis
Results
Patient characteristics
Total Sample (N = 127,423) | Initiated Depression Treatment (n = 108,457) | No Depression Treatment (n = 18,966) | Past month PHQ9 (n = 13,610) | |
---|---|---|---|---|
Age (years) | 34.57 (8.88) | 34.53 (8.81) | 34.84 (9.29) | 34.25 (8.80) |
Gender (Male) | 107,243 (84.2) | 90,525 (83.5) | 16,718 (88.1) | 11,520 (84.6) |
Race/Ethnicity | ||||
White non-Hispanic | 75,293 (59.1) | 63,834 (58.9) | 11,459 (60.4) | 8045 (59.1) |
Black non-Hispanic | 25,536 (20.0) | 22,059 (20.3) | 3477 (18.3) | 2821 (20.7) |
Hispanic | 16,065 (12.6) | 13,775 (12.7) | 2290 (12.1) | 1553 (11.4) |
Other | 10,529 (8.3) | 8789 (8.1) | 1740 (9.2) | 1191 (8.8) |
American Indian/Alaska Native | 1483 (1.2) | 1279 (1.2) | 204 (1.1) | 167 (1.2) |
Asian | 2576 (2.0) | 2145 (2.0) | 431 (2.3) | 279 (2.0) |
Native Hawaiian/Other Pacific Islander | 1615 (1.3) | 1366 (1.3) | 249 (1.3) | 186 (1.4) |
Unknown | 8607 (6.8) | 7145 (6.6) | 1462 (7.7) | 977 (7.2) |
Marital Status | ||||
Married | 61,074 (47.9) | 52,143 (48.1) | 8931 (47.1) | 6470 (47.5) |
Divorced/Separated/Widowed | 33,598 (26.4) | 28,936 (26.7) | 4662 (24.6) | 3486 (25.6) |
Never married | 31,733 (24.9) | 26,545 (24.5) | 5188 (27.4) | 3522 (25.9) |
Not reported | 1018 (0.8) | 833 (0.8) | 185 (1.0) | 132 (1.0) |
Driving distance to PC b | 15.02 (14.43) | 15.03 (14.40) | 15.00 (14.56) | 15.22 (13.93) |
Driving distance to SC b | 44.59 (42.26) | 44.53 (42.04) | 44.88 (43.38) | 45.66 (39.72) |
Driving distance to TC b | 95.01 (135.99) | 94.75 (136.48) | 96.44 (133.38) | 90.14 (113.77) |
Rural (Yes) | 29,650 (23.3) | 25,065 (23.1) | 4585 (24.2) | 3570 (26.2) |
Service connected (Yes) | 116,419 (91.4) | 100,002 (92.2) | 16,417 (86.6) | 12,095 (88.9) |
Nosos Score (year) | 0.57 (0.72) | 0.57 (0.74) | 0.54 (0.65) | 0.50 (0.63) |
Health care cost (year) | 4756.81 (11322.94) | 4820.57 (11675.74) | 4434.28 (9329.78) | 3815.29 (7480.77) |
Total health care visits (year) | 34.59 (55.67) | 33.39 (53.60) | 41.44 (65.84) | 25.94 (40.18) |
Total Sample (N = 127,423) | Initiated Depression Treatment (n = 108,457) | No Depression Treatment (n = 18,966) | Past month PHQ9 (n = 13,610) | |
---|---|---|---|---|
History of MH treatment type b | ||||
None | 107,621 (84.5) | 92,105 (84.9) | 15,516 (81.8) | 12,271 (90.2) |
Psychotherapy | 4172 (3.3) | 3308 (3.1) | 864 (4.6) | 276 (2.0) |
Antidepressants | 11,113 (8.7) | 9367 (8.6) | 1746 (9.2) | 818 (6.0) |
Both | 4517 (3.5) | 3677 (3.4) | 840 (4.4) | 245 (1.8) |
Comorbid MH disorders | ||||
Adjustment | 9217 (7.2) | 7993 (7.4) | 1224 (6.5) | 783 (5.8) |
Anxiety | 6140 (4.8) | 5331 (4.9) | 809 (4.3) | 515 (3.8) |
Alcohol | 7037 (5.5) | 6105 (5.6) | 932 (4.9) | 606 (4.5) |
Substance | 2017 (1.6) | 1782 (1.6) | 235 (1.2) | 152 (1.1) |
PTSD | 30,165 (23.7) | 26,015 (24.0) | 4150 (21.9) | 2381 (17.5) |
No Comorbidity | 84,727 (66.5) | 71,643 (66.1) | 13,084 (69.0) | 10,013 (73.6) |
Past month depression screen | ||||
Negative PHQ-2 screen | 529 (0.4) | 469 (0.4) | 60 (0.3) | 529 (3.9) |
Positive PHQ-2 screen | 10,915 (8.6) | 9192 (8.5) | 1723 (9.1) | 10,915 (80.2) |
PHQ-2 score | 4.54 (1.33) | 4.57 (1.34) | 4.40 (1.26) | 4.54 (1.33) |
Negative PHQ-9 screen | 1757 (1.4) | 1438 (1.3) | 319 (1.7) | 1757 (12.9) |
Positive PHQ-9 screen | 11,853 (9.3) | 10,148 (9.4) | 1705 (9.0) | 11,853 (87.1) |
PHQ-9 score | 15.76 (5.3) | 15.93 (5.35) | 14.73 (5.13) | 15.76 (5.33) |
Anhedonia item | 2.16 (0.92) | 2.18 (0.92) | 2.09 (0.95) | 2.16 (0.92) |
Suicide item | 0.45 (0.84) | 0.47 (0.85) | 0.36 (0.78) | 0.45 (0.84) |
First depression diagnosis | ||||
Mild episode | 107,093 (84.0) | 90,381 (83.3) | 16,712 (88.1) | 11,355 (83.4) |
Single episode | 100,006 (78.5) | 84,604 (78.0) | 15,402 (81.2) | 10,930 (80.3) |
Time to depression treatment | ||||
< 1 week | 39,798 (31.2) | 39,798 (36.7) | - | 4522 (33.2) |
< 1 month | 13,167 (10.3) | 13,167 (12.1) | - | 1472 (10.8) |
< 3 months | 18,349 (14.4) | 18,349 (16.9) | - | 1957 (14.4) |
< 6 months | 9776 (7.7) | 9776 (9.0) | - | 1005 (7.4) |
< 1 year | 6752 (5.3) | 6752 (6.2) | - | 714 (5.2) |
> 1 year | 20,615 (16.2) | 20,615 (19.0) | - | 1916 (14.1) |
Never | 18,966 (14.9) | - | 2024 (14.9) | |
Depression treatment type initiated | ||||
Psychotherapy | 43,386 (34.0) | 43,386 (40.0) | - | 4882 (35.9) |
Antidepressants | 60,297 (47.3) | 60,297 (55.6) | - | 6142 (45.1) |
Both | 4774 (3.7) | 4774 (4.4) | - | 562 (4.1) |
Predictors of lack of treatment initiation
Estimate | Wald Chi-Square | OR d | OR 95%CI | |
---|---|---|---|---|
Age (years) | 0.003 | 5.252 | 1.003 | 1.000-1.006 |
Gender (Male) | 0.378 | 86.839 | 1.460 | 1.348–1.581 |
Race/Ethnicity | ||||
White non-Hispanic | 0 | - | 1 | - |
Black non-Hispanic | − 0.086 | 6.507 | 0.917 | 0.859-0.980 |
Hispanic | − 0.048 | 1.572 | 0.953 | 0.884-1.028 |
Other a | 0.077 | 3.038 | 1.080 | 0.991-1.177 |
Marital Status | ||||
Married | 0 | - | 1 | - |
Divorced/Separated/Widowed | − 0.034 | 1.196 | 0.967 | 0.910-1.027 |
Never married | 0.106 | 11.626 | 1.112 | 1.046–1.182 |
Driving distance to SC b | < 0.001 | 0.985 | 1.000 | 1.000-1.001 |
Rural (Yes) | − 0.048 | 2.040 | 0.953 | 0.892-1.018 |
Service connected (No) | 0.515 | 208.448 | 1.673 | 1.560–1.795 |
NOSOS Score (year) | − 0.048 | 1.448 | 0.953 | 0.881-1.031 |
Health care cost (year) | < 0.001 | 0.907 | 1.000 | 1.000–1.000 |
Total health care visits (year) | 0.002 | 91.355 | 1.002 | 1.001–1.002 |
History of MH treatment type c | ||||
None | 0 | - | 1 | - |
Psychotherapy | 0.218 | 12.856 | 1.244 | 1.104–1.402 |
Antidepressants | 0.004 | 0.009 | 1.004 | 0.922-1.094 |
Both | 0.003 | 0.002 | 1.003 | 0.876-1.149 |
Comorbid MH disorders | ||||
Adjustment | − 0.113 | 2.917 | 0.893 | 0.784-1.017 |
Anxiety | − 0.121 | 2.991 | 0.886 | 0.773-1.016 |
Alcohol | − 0.043 | 0.453 | 0.958 | 0.845-1.086 |
Substance | − 0.523 | 16.850 | 0.593 | 0.462-0.761 |
PTSD | − 0.077 | 1.507 | 0.926 | 0.819-1.047 |
None | − 0.009 | 0.018 | 0.991 | 0.868-1.131 |
Depression screen | ||||
Negative PHQ-9 screen | 0 | - | 1 | - |
Positive PHQ-9 screen | − 0.159 | 2.469 | 0.853 | 0.699 − 1.040 |
PHQ-9 score | − 0.034 | 17.254 | 0.967 | 0.951-0.982 |
Anhedonia item | 0.048 | 1.071 | 1.049 | 0.958-1.148 |
Suicide item | − 0.033 | 0.517 | 0.968 | 0.884-1.059 |
First depression diagnosis | ||||
Mild episode | 0.269 | 35.612 | 1.309 | 1.198–1.430 |
Single episode | 0.064 | 2.910 | 1.066 | 0.990-1.148 |
Predictors of delayed treatment
Estimate | Wald-Chi-Square | OR d | OR 95%CI | |
---|---|---|---|---|
Age (years) | 0.007 | 34.754 | 1.007 | 1.005–1.010 |
Gender (Male) | 0.064 | 5.369 | 1.066 | 1.010–1.125 |
Race/Ethnicity | ||||
White non-Hispanic | 0 | - | 1 | - |
Black non-Hispanic | − 0.054 | 4.114 | 0.948 | 0.900-0.998 |
Hispanic | − 0.012 | 0.146 | 0.988 | 0.931 − 1.050 |
Other a | − 0.040 | 1.114 | 0.961 | 0.892-1.035 |
Marital Status | ||||
Married | 0 | - | 1 | - |
Divorced/Separated/Widowed | 0.012 | 0.230 | 1.012 | 0.965-1.061 |
Never married | − 0.034 | 1.712 | 0.966 | 0.918-1.017 |
Driving distance to SC b | − 0.001 | 6.029 | 0.999 | 0.999-1.000 |
Rural (Yes) | − 0.080 | 8.554 | 0.923 | 0.876-0.974 |
Service connected (No) | 0.335 | 72.651 | 1.397 | 1.294–1.509 |
NOSOS Score (year) | − 0.052 | 3.092 | 0.949 | 0.896-1.006 |
Health care cost (year) | < 0.001 | 3.403 | 1.000 | 1.000–1.000 |
Total health care visits (year) | < 0.001 | 1.009 | 1.000 | 0.999-1.000 |
History of MH treatment type c | ||||
None | 0 | - | 1 | - |
Psychotherapy | 0.596 | 85.265 | 1.815 | 1.599–2.059 |
Antidepressants | 0.239 | 40.270 | 1.270 | 1.180–1.368 |
Both | 0.719 | 122.326 | 2.052 | 1.806–2.331 |
Comorbid disorders | ||||
Adjustment | − 0.165 | 10.392 | 0.848 | 0.767-0.937 |
Anxiety | 0.252 | 21.486 | 1.286 | 1.156–1.430 |
Alcohol | 0.016 | 0.096 | 1.016 | 0.920-1.122 |
Substance | − 0.068 | 0.662 | 0.934 | 0.792-1.101 |
PTSD | − 0.170 | 12.123 | 0.843 | 0.766-0.928 |
None | − 0.184 | 12.015 | 0.832 | 0.750-0.923 |
Depression screen | ||||
Negative PHQ-9 screen | 0 | - | 1 | - |
Positive PHQ-9 screen | 0.258 | 5.664 | 1.294 | 1.047–1.601 |
PHQ-9 score | 0.033 | 15.873 | 1.033 | 1.017–1.050 |
Anhedonia item | − 0.002 | 0.001 | 0.998 | 0.913-1.092 |
Suicide item | 0.009 | 0.043 | 1.009 | 0.930-1.094 |
First depression diagnosis | ||||
Mild depression episode | − 0.326 | 101.093 | 0.722 | 0.677-0.769 |
Single depression episode | − 0.201 | 47.528 | 0.818 | 0.773-0.866 |
Identification of patients who never initiated treatment
Initiated Depression Treatment (n = 108,457) | No Depression Treatment (n = 18,966) | |
---|---|---|
True positive | 106,085 | 6301 |
False positive | 14,712 | 325 |
False Negative | 325 | 14,712 |
Precision | 0.87 | 0.95 |
Recall | 0.99 | 0.30 |
F-Measure | 0.93 | 0.46 |