Evaluating environmental risk factors for adolescent anxiety and depression in Pennsylvania using electronic health records

Abstract

Over the past decade, the use of electronic health records (EHRs) for epidemiologic studies has expanded due to their potential for longitudinally studying large sample sizes with lower budgets and less data collection time compared to primary data collection. The main purpose of EHRs is clinical, so researchers have to make many difficult decisions with the methods they use to define study populations, variables, and outcomes from information originally entered for a doctor's visit. There are even further challenges to overcome when using EHRs for studies in a particularly difficult area of epidemiology: the study of adolescent mental health outcomes. This poster will review some of the considerations for methods used in epidemiologic studies of psychiatric outcomes for children using EHRs, including options for how to define psychiatric outcomes in children and options for selecting controls given the common nonspecific use of mental health codes and their co-occurrence in children. Considerations and results specific to evaluating the association of new-onset adolescent depressive and anxiety disorders in Pennsylvania (with Geisinger subjects, who represent the general population of the region) with community and environmental risk factors will be shared. Risk factors evaluated include greenness, percent forest, distance to major road, community type, and urbanicity. While many studies have started to show an elevated odds of depressive and anxiety disorders amongst adults in urban versus rural areas, the signal is not clear across studies, none have been conducted with EHRs, and very few have evaluated the association amongst adolescents specifically, a critical developmental period for these disorders.