Living Well / Reducing Adult Depression

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: https://www.cdc.gov/brfss/data_documentation/pdf/userguidejune2013.pdf

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

Program URL Link: https://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: https://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., https://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: https://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. https://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: https://www.cdph.ca.gov/programs/Documents/BurdenReportOnline%2004-04-13.pdf