Depression Symptoms and Treatment

The MEPS used the Patient Health Questionnaire-2 (PHQ-2), a brief screen for depressed mood and anhedonia during the past 2 weeks, to screen for depression. A PHQ-2 score of 3 or more (scores range from 0 to 6, with higher scores indicating more severe depressive symptoms) defined screen-positive depression. In primary care patients, a PHQ-2 score of 3 or more has a sensitivity of 0.61 to 0.87 and specificity of 0.78 to 0.92 for major depressive disorder which refers to more severe rather than mild depression.19-21 In a validation study of 88 primary care patients with a PHQ-2 score of 3 or more, 34 (38.6%) had major depressive disorder, 32 (36.3%) had other less severe depression, and 22 (25.0%) had neither type of depression.19

Detailed data were collected directly from households using 3 interviews during each survey year. Treatment of depression was defined by an outpatient visit or use of antidepressant, antipsychotic, mood stabilizer, or anxiolytic medications, or psychotherapy for depression (International Classification of Diseases, 9th Revision, codes 296.2, 296.3, 300.4, and 311) without regard to clinical effectiveness. Patients treated for bipolar disorder were excluded from the definition of depression treatment.

Respondents indicated whether each visit included psychotherapy or mental health counseling. One or more psychotherapy or counseling visits defined use of psychotherapy. Three groups were defined: any psychotherapy, any antidepressant treatment, and combination treatment. Information was also collected concerning the health care professionals providing treatment at each visit. Respondents were classified into those who received depression treatment from (1) any psychiatrist, (2) any social worker or psychologist, and (3) only general medical professionals (ie, health care professionals other than psychiatrists, psychologists, or social workers). The 2 mental health specialty groups were not mutually exclusive.