Joyce T. Berry

The PHQ-8 as a measure of current depression in the general population.

BACKGROUND The eight-item Patient Health Questionnaire depression scale (PHQ-8) is established as a valid diagnostic and severity measure for depressive disorders in large clinical studies. Our objectives were to assess the PHQ-8 as a depression measure in a large, epidemiological population-based study, and to determine the comparability of depression as defined by the PHQ-8 diagnostic algorithm vs. a PHQ-8 cutpoint > or = 10. METHODS Random-digit-dialed telephone survey of 198,678 participants in the 2006 Behavioral Risk Factor Surveillance Survey (BRFSS), a population-based survey in the United States. Current depression as defined by either the DSM-IV based diagnostic algorithm (i.e., major depressive or other depressive disorder) of the PHQ-8 or a PHQ-8 score > or = 10; respondent sociodemographic characteristics; number of days of impairment in the past 30 days in multiple domains of health-related quality of life (HRQoL). RESULTS The prevalence of current depression was similar whether defined by the diagnostic algorithm or a PHQ-8 score > or = 10 (9.1% vs. 8.6%). Depressed patients had substantially more days of impairment across multiple domains of HRQoL, and the impairment was nearly identical in depressed groups defined by either method. Of the 17,040 respondents with a PHQ-8 score > or = 10, major depressive disorder was present in 49.7%, other depressive disorder in 23.9%, depressed mood or anhedonia in another 22.8%, and no evidence of depressive disorder or depressive symptoms in only 3.5%. LIMITATIONS The PHQ-8 diagnostic algorithm rather than an independent structured psychiatric interview was used as the criterion standard. CONCLUSIONS The PHQ-8 is a useful depression measure for population-based studies, and either its diagnostic algorithm or a cutpoint > or = 10 can be used for defining current depression.

The association of depression and anxiety with obesity and unhealthy behaviors among community-dwelling US adults

OBJECTIVE The aim of this study was to examine the extent to which depression and anxiety are associated with smoking, obesity, physical inactivity and alcohol consumption in the US population using the Patient Health Questionnaire 8 (PHQ-8) and two questions on lifetime diagnosis of anxiety and depression. METHODS Data were analyzed in 38 states, the District of Columbia and two territories using the 2006 Behavioral Risk Factor Surveillance System (n=217,379), a large state-based telephone survey. RESULTS Overall, adults with current depression or a lifetime diagnosis of depression or anxiety were significantly more likely than those without each diagnosis to smoke, to be obese, to be physically inactive, to binge drink and drink heavily. There was a dose-response relationship between depression severity and the prevalence of smoking, obesity and physical inactivity and between history of depression (never depressed, previously depressed, currently depressed) and the prevalence of smoking, obesity, physical inactivity, binge drinking and heavy drinking. Lifetime diagnosis of depression and anxiety had an additive association with smoking prevalence. CONCLUSION The associations between depression, anxiety, obesity and unhealthy behaviors among US adults suggest the need for a multidimensional and integrative approach to health care.

Impact of Depression and Anxiety on Quality of Life, Health Behaviors, and Asthma Control Among Adults in the United States with Asthma, 2006

Background. Psychological factors such as anxiety and depression are increasingly being recognized as influencing the onset and course of asthma. Methods. We obtained Patient Health Questionnaire 8 depression data from 41 states and territories using the 2006 Behavioral Risk Factor Surveillance System. Heath risk behaviors, social and emotional support, life satisfaction, disability, and four health-related quality-of-life (HRQOL) questions were available for all states and territories (n = 18,856 with asthma). Five additional HRQOL questions were asked in three states (n = 1345 persons with asthma), and questions assessing asthma control were available for nine states (n = 3943 persons with asthma). Results. Persons with asthma were significantly more likely than those without asthma to have current depression (19.4% vs. 7.7%), a lifetime diagnosis of depression (30.6% vs. 14.4%), and anxiety (23.5% vs. 10.2%). For most domains examined, there was a dose-response relationship between level of depression severity and mean number of days of impaired HRQOL in the past 30 days, as well as an increased prevalence of life dissatisfaction, inadequate social support, disability, and risk behaviors, such as smoking, physical inactivity, and obesity, among those with asthma. Moreover, depression and anxiety were associated with a decreased level of asthma control, including more visits to the doctor or emergency room, inability to do usual activities, and more days of symptoms compared to those without depression or anxiety. Conclusion. This research indicates that a multidimensional, integrative approach to health care should be considered when assessing patients with asthma.

The associations between depression, health-related quality of life, social support, life satisfaction, and disability in community-dwelling US adults.

The purpose of this manuscript is to describe the associations among current depression, as measured by the Patient Health Questionnaire 8, health-related quality of life, social support, life satisfaction, and disability status, using the 2006 Behavioral Risk Factor Surveillance System. A dose-response relationship exists between depression severity and mean number of days in the past 30 days of physical distress, pain, anxiety symptoms, and activity limitations as well as the prevalence of fair/poor general health, life dissatisfaction, inadequate social support, and disability. These profound associations underscore the need for recognition and treatment of depression in all healthcare settings.

Undertreatment of Mental Health Problems in Adults With Diagnosed Diabetes and Serious Psychological Distress The Behavioral Risk Factor Surveillance System, 2007

OBJECTIVE To assess the prevalence and correlates of undertreatment for mental health problems among adults with diabetes and serious psychological distress (SPD). RESEARCH DESIGN AND METHODS We analyzed data of adults aged ≥18 years from the 2007 Behavioral Risk Factor Surveillance System. SPD was assessed with the Kessler-6 scale. RESULTS The prevalence of untreated SPD was estimated to be 2.1 ± 0.1% (mean ± SE), 3.4 ± 0.3%, and 2.0 ± 0.1% in the total population, diabetic population, and nondiabetic population, respectively. Among people with SPD, those with diagnosed diabetes had a lower rate of undertreatment for mental health problems (45.0%) than those without diabetes (54.9%) (P = 0.002). Nonwhite race/ethnicity, advanced age, lack of health insurance, and currently being employed were associated with increased likelihood of undertreatment for mental health problems (P < 0.05). CONCLUSIONS People with diagnosed diabetes may be screened for SPD and treated for specific mental health problems in routine health care.

The relationship between smoking status and serious psychological distress: findings from the 2007 Behavioral Risk Factor Surveillance System

Objectives:To examine the associations between smoking and quit attempts with psychological distress and also by socioeconomic groups.Methods:Using data on 172,938 adult respondents from the 2007 Behavioral Risk Factor Surveillance System we used the Kessler-6 scale to assess psychological distress among never, former, some-day, and everyday smokers and smokers attempting to quit.Results:Everyday smokers and attempting quitters had higher mean levels of 30-day psychological distress than never smokers. Compared with never smokers, the odds of having serious psychological distress (SPD) were: former smokers, 1.3 (95 % CI: 1.1–1.6); some-day smokers, 2.5 (95 % CI: 2.0–3.1); and everyday smokers, 3.3 (95 % CI: 2.8–3.8). As for unsuccessful quit attempts, the odds were highest for current smokers (3.3 [95 % CI: 2.8–3.8]) versus never smokers. Among current smokers, persons with less than high school education, income less than

Association between diagnosed diabetes and serious psychological distress among U.S. adults: the Behavioral Risk Factor Surveillance System, 2007

50,000, or who were unemployed or unable to work had the highest odds of reporting SPD.Conclusions:Given the association between current smoking behaviors and psychological distress, future tobacco prevention and control efforts may benefit by including components of mental health, especially for low SES populations.

Rural-urban variations in psychological distress: findings from the Behavioral Risk Factor Surveillance System, 2007

Objectives:To estimate the prevalence of serious psychological distress (SPD) according to diabetes status and to assess the association of diabetes-related risks and conditions with SPD among U.S. adults.Methods:We analyzed data from the Behavioral Risk Factor Surveillance System, 2007. SPD was determined by a score of ≥ 13 on the Kessler-6 scale. We used log-binomial regression analysis to estimate prevalence ratios (PRs) and 95 % confidence intervals (CIs).Results:We estimated the prevalence of SPD to be 7.6 % and 3.6 % among U.S. adults with and without diagnosed diabetes (unadjusted PR: 2.09; 95 % CI: 1.87, 2.34). The association of diagnosed diabetes with SPD was attenuated after adjustments for potential confounding effects of cardiovascular risk factors and cardiovascular comorbid conditions (adjusted PR, 1.12; 95 % CI: 0.99, 1.27). Significant correlates of SPD among persons with diagnosed diabetes were young age, low education levels, low household income, obesity, current smoking, no leisure-time physical activity, presence of one or more micro- or macro-vascular complications, and disability.Conclusions:The crude prevalence of SPD among adults with diagnosed diabetes was twice as high as that among those without diabetes. The increased prevalence of SPD may be accounted for by the excessive rates of cardiovascular risks and comorbid conditions among people with diagnosed diabetes.

State-based differences in the prevalence and characteristics of untreated persons with serious psychological distress.

Abstract.Objectives:To describe rural and urban differences in the prevalence and correlates of psychological distress in the United States.Methods:We analyzed 2007 Behavioral Risk Factor Surveillance System (BRFSS) data from 62,913 respondents residing in 94 counties in 24 states, and District of Columbia that administered the Kessler-6 (K6) psychological distress questionnaire and met the BRFSS weighting criterion. Using the Rural Urban Classification Codes (RUCC), 94 counties fell into four groups (two metropolitan and two non-metropolitan) out of the nine-part RUCC scheme; these levels were collapsed into two distinct categories of urban and rural.Results:Unadjusted estimates indicate that urban county residents have a 22 % higher likelihood of having either MPD or SPD than rural residence (odds ratio [OR]: 1.22, 95 % confidence interval [CI]: 1.09–1.36). This association was slightly attenuated after adjusting for sociodemographic characteristics 17 % higher (OR: 1.17, 95 % CI: 1.04–1.31).Conclusion:This is the first study to our knowledge reporting rural and urban prevalence of psychological distress derived from population-based, county-level data for 94 counties in the United States.

Psychological Distress Severity of Adults Reporting Receipt of Treatment for Mental Health Problems in the BRFSS

Objectives:To examine the state-based prevalence of serious psychological distress (SPD) and its treatment using the Kessler-6 scale.Methods:SPD and treatment data were obtained from 202,114 respondents in the 2007 Behavioral Risk Factor Surveillance System Mental Illness and Stigma Module in 35 states, the District of Columbia, and Puerto Rico.Results:Approximately 4.0 % of persons in the 35 states, the District of Columbia, and Puerto Rico had SPD. The prevalence estimates ranged from 2.3 % in Iowa to 6.6 % in Mississippi. Among persons with SPD, 53.4 % were currently untreated, ranging from 33.3 % in Alaska to 67.0 % in Hawaii.Conclusions:Mental health parity and a multidimensional approach to healthcare with extensive referrals between mental and physical healthcare is warranted.