Living Well / Reducing Adult Depression

Depression is a common and treatable condition

Good health is not limited to physical health.1 Mental health and well-being are also important. Therefore, screening and treatment for depression is an important priority for the Living Well goal. Depression is a common and treatable condition which can have serious health consequences if left untreated.2 Let’s Get Healthy California seeks to reduce the number of adults and adolescents (teens) who experience a major depressive episode. Additional data needs to be developed in order to provide a measure for effectively diagnosing and treating depression in adolescents and adults.3

For resources regarding Mental Health services for various populations, please see the Mental Health Services Division website.

For details on County Mental Health Plans, including links on depression screening resources, please see the Mental Health Quality Improvement Work Plan website.

Adult Depression

In 2012 (baseline year), 11.7% of adults were told they had a depressive disorder. The most recent data available show 19.0% (2017). We hope to reach a target of no increase in prevalence compared to baseline by 2022.

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More Data

Baseline

11.7%

Current Rate

19.0%

Target

See text

Indicator Highlights

A Depressed man

California Reducing Disparities Project

California Reducing Disparities Project is a statewide policy initiative to develop strategies to transform the public mental health system and identify solutions for historically unserved, underserved, and inappropriately served communities.

The effort focuses on identifying, and evaluating community-based promising practices in each of five targeted populations: African Americans, Asians and Pacific Islanders (API), Latinos, Lesbian, Gay, Bisexual, Transgender, Queer, and Questioning (LGBTQ), and Native Americans.

There has not been a project of this scope before; one that recognizes and elevates community practices and identifies strategies for systems change. Throughout this process, California will present this work on the national stage so that other states can learn from our efforts.

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Culturally Competent Care

In California, almost one in six adults has a mental health need, including people of all races and ethnicities and all social, and economic, and education levels, but there are striking disparities in access to treatment and services.1 Issues such as stress and trauma related to immigration, racial discrimination, poverty, language barriers, and cultural differences play an especially important role, not only in the risk of having mental illness, but also in access to quality mental health services.4

Depression is a risk factor for the development of cardiovascular conditions and other chronic disease.4

Data Snapshot: Trends and Disparities

Almost three of four Mexican Americans who have a diagnosable mental disorder and need services remain untreated.4

More Native Americans and African Americans under 35 have seriously thought about committing suicide (27% and 18% respectively), compared to other racial/ethnic groups.4
White men have the highest age-adjusted rates of suicide (22 per 100,000 population) among all racial/ethnic groups.4
Studies show that rates of serious mental illness are more than four times as high among the lowest-income adults in California (less than 100 percent of the federal poverty level) than among those earning at least 300 percent of the poverty rate.1

Proportion of Adults Who Were Told They Had a Depressive Disorder, Over Time

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Proportion of Adults Who Were Told They Had a Depressive Disorder, by Demographic Category

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Indicator: Proportion of adults who were ever told they had a depressive disorder (including depression, major depression, dysthymia, or minor depression)

Indicator Description: Based on the question “Has a doctor, nurse or other health professional EVER told you that you have a depressive disorder (including depression, major depression, dysthymia, or minor depression)?” from the Behavioral Risk Factor Surveillance System (BRFSS), a nationally coordinated, state-based, telephone-administered survey of adults. The cross-sectional health survey provides annual state-level population health estimates for health-related risk behaviors, preventive health practices, and chronic disease and injury.

Data Limitations: Limitations include: 1) relies on self-reported information, 2) provides prevalence, not incidence data (thus the target at best can match baseline; it can’t be lower than baseline), 3) bias or measurement error associated with telephone-administered survey of a sample of the population ( e.g., response bias, sampling variation), 4) designed to provide state-level population health estimates. CDC BRFSS Data Documentation 2016, 5) respondents were not asked what age they were at the time of diagnosis, therefore data could not be stratified by age.

The use of “health professional” in the question limits the estimated prevalence to diagnoses by physical health practitioners and does not clearly include mental health professionals. As a result, an unknown percentage of respondents who were diagnosed by a mental health professional may have answered “No,” when the answer should have been “Yes”.

By counting only those respondents who have been professionally diagnosed with depression, the new indicator cannot account for those individuals who, although suffering from any of the depressive spectrum disorders, may not have reported or sought help from a health professional. This could significantly underestimate the lifetime prevalence rate.  This underestimation will be relatively higher in subpopulations who have a greater lack of access to healthcare.

Indicator Source: 2012 and 2013 use the CDC BRFSS data (using California only). 2014 and 2015 are from the California BRFSS data. This is because in 2014, California BRFSS changed their weighting methodology to match that of the CDC. Versions prior to 2012 of the California BRFSS are not comparable to 2012 and later California BRFSS because of these methodology changes.

Indicator Calculation Methodology: http://www.cdc.gov/brfss/data_documentation/pdf/userguidejune2013.pdf

Data Collection Methodology: http://www.cdc.gov/brfss/data_documentation/index.htm

Program URL Link: http://www.cdc.gov/brfss/data_documentation/index.htm

Indicator Source Changes: Because of the changes in the methodology, researchers are advised to avoid comparing data collected before the changes (up to 2011) with data collected from 2012 and onward: http://www.cdc.gov/brfss/annual_data/2013/pdf/compare_2013.pdf

1. Office of Health Equity. (August 2015). Portrait of Promise: California Statewide Plan to Promote Health Equity and Mental Health Equity. California Department of Public Health., http://www.cdph.ca.gov/programs/Documents/CDPHOHEDisparityReportAug2015.pdf

2. Peck, C., Logan, J., Malzlish, N., & Van Court, J. (n.d.). The Burden of Chronic Disease. Retrieved November 16, 2015, from www.cdph.ca.gov: http://www.cdph.ca.gov/programs/Documents/BurdenReportOnline%2004-04-13.pdf

3. Let’s Get Healthy California Task Force. (December 2012). Lets Get Healthy California Task Force Final Report. Let’s Get Healthy California Task Force. http://www.chhs.ca.gov/pages/LGHCTF.aspx

4. Peck, C., Logan, J., Malzlish, N., & Van Court, J. (n.d.). The Burden of Chronic Disease. Retrieved November 16, 2015, from www.cdph.ca.gov: http://www.cdph.ca.gov/programs/Documents/BurdenReportOnline%2004-04-13.pdf

Stories & Solutions

California Reducing Disparities Project – Phase 1

Focuses on developing strategies to transform the public mental health system and identifying community-based promising practices in each of the five targeted populations. Read more »

California Reducing Disparities Project – Phase 2

Focus on funding and evaluating the promising practices identified in Phase 1, as well as advancing the strategies outlined in this plan. There has not been a project of this scope before; one that recognizes and elevates community practices and identifies strategies for systems change. Throughout this process, California will [...]

California Reducing Disparities Project – Stakeholder Generated Reports

Stakeholder workgroups focusing on five populations developed individual Population Reports that included recommendations for reducing disparities and removing barriers to accessing programs and services, along with an inventory of community-defined evidence and promising practices that could support efforts to reduce disparities.

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