Nevada Behavioral Risk Factor Surveillance System (BRFSS): Depression and Anxiety Module 2006 (preliminary results)

1. Nevada Behavioral Risk Factor Surveillance System (BRFSS):Depression and Anxiety Module 2006 (preliminary results) Wei Yang, M.D., Ph.D. University of Nevada-Reno Kevin Crowe, Ed.D. Nevada State Division of Mental Health Services William Lee, B.S. Nevada State Health Division

2. Objectives To assess mental health conditions and behaviors of Nevada population through Nevada BRFSS project.

3. BRFSS: Depression and Anxiety Module • 10 questions regarding depressive disorders and anxiety disorders, • The most prevalent mental illnesses, fostering both impaired work performance and increased health care utilization.

4. BRFSS: Depression and Anxiety Module • The first 8 questions consist of eight criteria on which the diagnosis of depressive disorders is based. • The remaining 2 questions assess healthcare professional diagnoses of depressive disorders and anxiety disorders.

5. BRFSS: Depression and Anxiety Module 1) Over the last 2 weeks, how many days have you had little interest or pleasure in doing things? 2) Over the last 2 weeks, how many days have you felt down, depressed or hopeless? 3) Over the last 2 weeks, how many days have you had trouble falling asleep or staying asleep or sleeping too much?

6. BRFSS: Depression and Anxiety Module 4) Over the last 2 weeks, how many days have you felt tired or had little energy? 5) Over the last 2 weeks, how many days have you had a poor appetite or ate too much? 6) Over the last 2 weeks, how many days have you felt bad about yourself – or that you were a failure or had let yourself or your family down?

7. BRFSS: Depression and Anxiety Module 7) Over the last 2 weeks, how many days have you had trouble concentrating on things, such as reading the newspaper or watching TV? 8) Over the last 2 weeks, how many days have you moved or spoken so slowly that other people could have noticed? Or the opposite – being so fidgety or restless that you were moving around a lot more than usual?

8. BRFSS: Depression and Anxiety Module 9) Has a doctor or other healthcare provider EVER told you that you have an anxiety disorder (including acute stress disorder, anxiety, generalized anxiety disorder, obsessive-compulsive disorder, panic attacks, panic disorder, phobia, posttraumatic stress disorder, or social anxiety disorder).

9. BRFSS: Depression and Anxiety Module 10) Has a doctor or other healthcare provider EVER told you that you have a depressive disorder (including depression, major depression, dysthymia, or minor depression)?

10. Sampling Method • Disproportionate Stratified Sample (DSS): Las Vegas, Reno, Other Areas • Randomly selected throughout the state • Omit Business and nonworking numbers • Age 18 yrs • Specially Trained Interviewers • Computer Assisted Telephone Interview (CATI)

11. Data Analyses Methods • Descriptive analyses for weighted risk behavior prevalence • Multiple logistic regression models Interaction Terms Confounding factors

12. Data Analyses Methods: Descriptive analyses • Descriptive analyses for weighted risk behavior prevalence Weighting Process: FINALWT=GEOWT*DENWT*(1/NPH)* NAD*CSA*POSTSTRAT

13. Data Analyses Methods: Descriptive analyses • GEOWT: Basic probability of selection among strata (subsets of area code/prefix combinations) • DENWT: Density • 1/NPH: Number of residential telephone numbers • NAD: Number of adults • CSA: Expected/actual cluster size • POSTSTRAT: age, race, sex adjustment to population

14. Data Analyses Methods: Multiple Logistic Regression SURVEYLOGISTIC • STRATUM, CLUSTER, WEIGHT • MODEL: Logit P(X) = α + βE + ∑V +∑W • E=Exposure, V=Potential Confounding, W=Effective Modifiers

15. Data Analyses Methods: Multiple Logistic Regression Factor included: • Age, • Sex, • Residency Length, • Marital Status, • Family Size, • Education, • Employment Status, • Family Income, • Insurance, • Body Mass Index

16. Depression Severity Calculation Assigning scores: • 0-1 day – ‘not at all’ = 0 • 2-6 days – ‘several days’ = 1 • 7-11 days – ‘more than half the days,’ = 2 • 12-14 days – ‘nearly every day,’ respectively = 3

17. Severity Calculation Ranges from 0-24: • 0-4 = No Depression • 5- = Mild, • 10- = Moderate, • 15- = Moderately Severe, • 20-24 = Severe Depression (Respondent must answered between 0 and 14 days for all 8 questions for this score to be valid)

18. Respondents (Complete Surveys the first 11 months of 2006) Depression (score 5-24) Yes No Total 715 2,743 2028 (27.0%) (73.0%)

19. Respondents (Complete Surveys the first 11 months of 2006) Moderately Severe/Severe (score 15-24) Yes No Total 99 2,743 2,644 (3.5%) (96.5%)

20. Depression Results 1: Depression (score 5-24) Prevalence: 27.0% (C.I. 95%: 24.4 - 29.6%)

26. Logistic Regression: Some Level of Depression (significant, either directions) • Female • Age 18-24 • College Education • Income <$15k • Obese • Fair/Poor Health

27. Severe Depression Results 2: Severe Depression (score 15-24) Prevalence: 3.5% (C.I. 95%: 2.5 - 4.5%) 2006 Nevada Population: 2,624,115 91,844

33. Logistic Regression: Severe Depression (significant, either directions) • Age 45-54 • Age 65+ • Income <$15k • Obese • Fair/Poor Health

34. Healthcare Provider Diagnoses Results 3: Healthcare Provider Diagnoses • Anxiety Disorder: 11.3% • Depressive Disorder: 15.7%

35. Conclusions 1: Prevalence • 11.3% anxiety disorder told by provider • 15.7% depressive disorder told by provider • 27.0% some level of depression • 3.5% moderately severe/severe depression

36. Conclusions 2: Risk Factors for Some Degree of Depression • Females • Younger age group • Lower education level • Lower income • Obesity • People who identify their health as fair or poor

37. Conclusions 3: Risk Factors for Severe Depression • Older Age Groups • Lower Income • Obesity • People who identify their health as fair or poor

38. Next Steps • Complete 2006 data • Detailed analysis for each risk factor • National and regional comparisons

39. BRFSS Data and Nevada State Mental Health Agency • Review of BRFSS data as monitoring indicators • Nevada, Regional and national standings? • Focus on special populations/regions which show at higher risks

40. Questions? Wei Yang, M.D., Ph.D., Professor and Director, Nevada Center for Health Statistics and Informatics, University of Nevada-Reno weiyang@unr.edu 775-682-7094