Burden of Moderate to Severe Depression in the US Adult Population

Abstract

To better understand the characteristics and burden of moderate/severe depression in the United States(US). A random stratified sampling framework was used in a 2016 survey of the US adult population to assess health conditions and impact on health related quality of life(HRQoL). Validated HRQoL and screening questionnaires for depression and anxiety were employed. Respondents with no/mild depression were compared to respondents with moderate/severe depression. Chi-squares for categorical data and general linear models were used to analyze comorbidities, age, race, medication use, productivity and resource utilization. Logistic regressions were used to assess predictors of moderate/severe depression. Approximately 16% of the US adult population reported PHQ-9 scores above 14(moderate/severe depression). Respondents with moderate/severe depression compared to those with no/mild depression had a significantly lower Physical Health Composite Score(PCS)(40.26 vs. 48.84; p<0.01) and Mental Health Composite Score(MCS)(30.96 vs. 53.77; p<0.01), as well as a lower health utility(0.56 vs. 0.78 p<0.01). Those with moderate/severe depression reported significantly lower levels of restorative sleep, as measured with the Restorative Sleep Questionnaire(36.85 vs. 72.38; p<0.01), and were more likely to report difficulty initiating sleep(DIS) (47.32 vs. 4.90; p<0.01) and difficulty maintaining sleep(DMS)(53.93 vs 9.53; p<0.01). Those with moderate/severe depression had more hours lost over the last week due to health problems(7.35 vs. 1.10; p<0.01) and were more likely to visit the emergency department (36.50% vs 10.19%; p<0.01) or have a hospital visit(23.84% vs. 6.67%; p<0.01) over the last 6 months. A logistic regression predicting moderate/severe depression(PHQ-9 < 4 vs. > 14) found age (OR 0.95; p<0.01), high blood pressure(OR=1.54; p=0.04), kidney disease(OR 6.20; p<0.01), anxiety(OR 5.02; p<0.01), DIS(5.29; p<0.01), DMS(4.55; p<0.01) predictive of moderate/severe depression. This study identifies factors predicting moderate/severe depression in US. Understanding these factors may provide direction on best practices to help improve care benefiting both patients and society.