Missed Opportunities for Depression Screening and Treatment in the United States

Abstract

Purpose: This study estimates the prevalence of depression assessment in adults age 35 and older and how prevalence varies by sociodemographic characteristics and depressive symptoms.

Methods: We used a nationally representative survey, the Agency for Healthcare Research and Quality's Medical Expenditure Panel Survey, to evaluate if adults 35+ were being assessed for depression by their health care providers in 2014 and 2015. Using multivariate logistic regression, we examined the health and sociodemographic characteristics of patients associated with depression assessment.

Results: Approximately 50% of US adults aged 35+ were being assessed for depression (48.6%; 95% CI, 45.5%-51.6%). The following were less likely to be assessed: men compared with women (OR, 0.58; 95% CI, 0.46-0.72), adults 75+ compared with adults 50 to 64 years old (OR, 0.47; 95% CI, 0.32-0.69), the uninsured compared with those with private insurance (OR, 0.30; 95% CI, 0.18-0.51), and adults without recognized depressive symptoms compared with those with recognized symptoms (OR, 0.39; 95% CI, 0.24-0.63). Compared with non-Hispanic whites, the following were less likely to be assessed: Asian (OR, 0.35; 95% CI, 0.19-0.67), Hispanic (OR, 0.47; 95% CI, 0.29-0.75), and African American (OR, 0.42; 95% CI, 0.27-0.67).

Conclusions: Many Americans are not having their depression needs assessed. Certain populations are more likely to be missed, including men, people over 75 years old, minorities, and the uninsured. Additional efforts are needed to determine methods to increase screening recommended by the United States Preventive Services Task Force and to ensure that all Americans have their mental health needs met.

Keywords: Depression; Health Personnel; Health Services Research; Logistic Models; Medically Uninsured; Mental Health; Prevalence; Surveys and Questionnaires.