Table 3.
Associations with self-reporting MDD among participants with a recorded history of MDD.
|
Self-reported history of depression among EHR-MDD |
|||
|---|---|---|---|
| Participant characteristics | Positive (n = 6689) | Negative (n = 2720) | aOR (95 % CI)a |
| Sociodemographic characteristics,n(row %) | |||
| Age at enrollment | |||
| 18–44 | 1643 (78.9 %) | 439 (21.1 %) | Reference |
| 45–54 | 1392 (75 %) | 465 (25 %) | 0.82 (0.71,0.95) |
| 55–64 | 1742 (73.7 %) | 621 (26.3 %) | 0.79 (0.69,0.91) |
| 65 + | 1912 (61.5 %) | 1195 (38.5 %) | 0.47 (0.41,0.53) |
| Gender Identity | |||
| Female | 5073 (73.4 %) | 1839 (26.6 %) | Reference |
| Male | 1616 (64.7 %) | 881 (35.3 %) | 0.71 (0.65,0.79) |
| Race | |||
| White | 6188 (71.5 %) | 2471 (28.5 %) | Reference |
| Black or African American | 44 (67.7 %) | 21 (32.3 %) | 0.67 (0.39,1.16) |
| Asian | 30 (57.7 %) | 22 (42.3 %) | 0.45 (0.26,0.81) |
| American Indian, Alaska Native, Native Hawaiian, or Pacific Islander |
11 (64.7 %) | 6 (35.3 %) | 0.66 (0.24,1.96) |
| Multi-racial | 356 (68.7 %) | 162 (31.3 %) | 0.95 (0.78,1.16) |
| Other | 26 (57.8 %) | 19 (42.2 %) | 0.51 (0.28,0.94) |
| Ethnicity | |||
| Non-Hispanic | 6539 (71.3 %) | 2635 (28.7 %) | Reference |
| Hispanic | 97 (68.3 %) | 45 (31.7 %) | 0.71 (0.50,1.04) |
| Education | |||
| High school or less | 1056 (66.2 %) | 540 (33.8 %) | 0.93 (0.80,1.07) |
| Some college | 2622 (72.8 %) | 981 (27.2 %) | 1.09 (0.96,1.23) |
| College graduate | 1543 (71.6 %) | 612 (28.4 %) | Reference |
| Postgraduate | 1358 (72.2 %) | 523 (27.8 %) | 1.17 (1.02,1.35) |
| Marital status | |||
| Married or marriage-like | 4579 (69.9 %) | 1972 (30.1 %) | Reference |
| Separated/Divorced | 887 (77.9 %) | 252 (22.1 %) | 1.44 (1.24,1.68) |
| Widowed | 378 (61.3 %) | 239 (38.7 %) | 0.85 (0.71,1.02) |
| Never married | 677 (78.3 %) | 188 (21.7 %) | 1.23 (1.03,1.47) |
| Unemployed under age 65 | |||
| No | 5021 (69.0 %) | 2251 (31.0 %) | Reference |
| Yes | 1608 (78.4 %) | 442 (21.6 %) | 1.22 (1.07,1.40) |
| Health-related characteristics,n(row %) | |||
| Smoking status | |||
| Never | 3515 (70.8 %) | 1448 (29.2 %) | Reference |
| Former | 2468 (70.8 %) | 1017 (29.2 %) | 1.13 (1.02,1.24) |
| Current | 596 (75.5 %) | 193 (24.5 %) | 1.11 (0.93,1.32) |
| Alcohol use | |||
| Never | 1756 (70.4 %) | 737 (29.6 %) | Reference |
| Once a month or less | 1664 (74.4 %) | 574 (25.6 %) | 1.10 (0.96,1.25) |
| 2–4 a month | 1477 (71.4 %) | 593 (28.6 %) | 0.94 (0.83,1.08) |
| 2–3 a week | 822 (68.2 %) | 383 (31.8 %) | 0.84 (0.72,0.98) |
| 4–5 a week | 460 (69.3 %) | 204 (30.7 %) | 0.99 (0.82,1.20) |
| 6 or more a week | 472 (70.3 %) | 199 (29.7 %) | 1.09 (0.90,1.32) |
| Body mass index | |||
| Underweight | 71 (74.7 %) | 24 (25.3 %) | 1.13 (0.71,1.86) |
| Normal | 1629 (70.1 %) | 694 (29.9 %) | Reference |
| Overweight | 1952 (68.8 %) | 886 (31.2 %) | 1.07 (0.95,1.21) |
| Obese | 2663 (73.3 %) | 972 (26.7 %) | 1.28 (1.13,1.44) |
| Charlson index | |||
| 0 | 2130 (73.2 %) | 778 (26.8 %) | Reference |
| 1–2 | 1917 (73.1 %) | 706 (26.9 %) | 1.17 (1.04,1.33) |
| 3–4 | 688 (67.9 %) | 325 (32.1 %) | 1.10 (0.93,1.30) |
| 5 or more | 563 (65.8 %) | 292 (34.2 %) | 1.01 (0.85,1.21) |
| Anxiety disordersb | |||
| No | 4058 (68.4 %) | 1877 (31.6 %) | Reference |
| Yes | 2631 (75.7 %) | 843 (24.3 %) | 1.39 (1.26,1.53) |
| Attention-deficit/hyperactivity disorderb | |||
| No | 6446 (70.7 %) | 2677 (29.3 %) | Reference |
| Yes | 243 (85.0 %) | 43 (15.0 %) | 1.93 (1.40,2.72) |
| Substance use disordersb | |||
| No | 5390 (70.7 %) | 2233 (29.3 %) | Reference |
| Yes | 1299 (72.7 %) | 487 (27.3 %) | 1.07 (0.95,1.20) |
| Clinical characteristics,n(row %) | |||
| MDD Screen at enrollmentc | |||
| Negative | 5311 (68.2 %) | 2478 (31.8 %) | Reference |
| Positive | 1315 (87.3 %) | 191 (12.7 %) | 2.98 (2.54,3.51) |
| Total unique antidepressant classes | |||
| 0 | 385 (41.0 %) | 555 (59.0 %) | Reference |
| 1 | 2632 (67.8 %) | 1250 (32.2 %) | 3.27 (2.81,3.82) |
| 2 | 2073 (77.1 %) | 614 (22.9 %) | 5.45 (4.62,6.43) |
| 3 or more | 1599 (84.2 %) | 301 (15.8 %) | 8.98 (7.44,10.85) |
| Recency of last MDD episode | |||
| < 90days | 2051 (82.6 %) | 432 (17.4 %) | Reference |
| 90days-< 1 yr | 1352 (78.8 %) | 363 (21.2 %) | 0.82 (0.70,0.96) |
| 1yr-< 3 yrs | 1644 (71.8 %) | 645 (28.2 %) | 0.58 (0.50,0.67) |
| 3yrs-< 5 yrs | 712 (64.4 %) | 393 (35.6 %) | 0.41 (0.35,0.48) |
| 5 yrs+ | 930 (51.2 %) | 887 (48.8 %) | 0.23 (0.20,0.26) |
| Social and emotional well-being characteristics,n(row %) | |||
| Overall mental well-being | |||
| 0–5 (low) | 1208 (84.9 %) | 215 (15.1 %) | 2.83 (2.42,3.33) |
| 6–7 (low normal) | 1705 (78.0 %) | 480 (22.0 %) | 1.82 (1.62,2.05) |
| 8 + (high normal) | 3763 (65.1 %) | 2017 (34.9 %) | Reference |
| Overall emotional well-being | |||
| 0–5 (low) | 1808 (85.4 %) | 310 (14.6 %) | 3.39 (2.96,3.89) |
| 6–7 (low normal) | 1965 (76.2 %) | 615 (23.8 %) | 1.87 (1.67,2.08) |
| 8 + (high normal) | 2906 (61.9 %) | 1787 (38.1 %) | Reference |
| Emotional health | |||
| Excellent | 236 (47.8 %) | 258 (52.2 %) | Reference |
| Very good | 1537 (61.8 %) | 949 (38.2 %) | 1.75 (1.44,2.13) |
| Good | 2121 (69.3 %) | 939 (30.7 %) | 2.42 (1.99,2.94) |
| Fair | 1919 (81.5 %) | 435 (18.5 %) | 4.58 (3.72,5.65) |
| Poor | 809 (88.7 %) | 103 (11.3 %) | 7.59 (5.78,10.04) |
| EHR Density,n(row %) | |||
| EHR length (years) | |||
| Q1: ≤ 2.62 | 966 (80.6 %) | 232 (19.4 %) | 1.86 (1.58,2.19) |
| Q2: 2.63–8.17 | 1664 (71.0 %) | 680 (29.0 %) | 1.17 (1.04,1.31) |
| Q3: 8.18–13.3 | 1833 (70.4 %) | 772 (29.6 %) | 1.11 (0.99,1.24) |
| Q4: 13.4 + | 2226 (68.2 %) | 1036 (31.8 %) | Reference |
| Diagnostic frequency (mean visits per year) | |||
| Q1: < 2.72 | 624 (72.9 %) | 232 (27.1 %) | 1.04 (0.87,1.23) |
| Q2: 2.72–5.82 | 1331 (68.6 %) | 610 (31.4 %) | 0.85 (0.75,0.97) |
| Q3: 5.83–11.6 | 2141 (69.9 %) | 921 (30.1 %) | 0.89 (0.80,1.00) |
| Q4: 11.7 + | 2593 (73.0 %) | 957 (27.0 %) | Reference |
| MDD Polygenic Risk Score | |||
| Continuous PRS (Linear) | |||
| Participants, n (missing) | 5303 (1386) | 2171 (549) | 1.10 (1.05,1.16) |
| PRS-MDD, median (IQR) | 0.2 (−0.5:0.9) | 0.1 (−0.6:0.8) | |
aOR, adjusted odds ratio; CI, confidence interval; EHR, electronic health record; IQR, interquartile range; MDD, major depressive disorder; PQ, participant questionnaire; Q, quartile.
a
Odds ratios and 95 % confidence intervals for participants with EHR-MDD, comparing participants that self-reported MDD history vs. those that did not. Adjusted for age, gender, and EHR length. Tests exploring age, gender and length of EHR were unadjusted for said variable.
b
Comorbidities were defined as the presence of at least one diagnostic code in a participants EHR.
c
Screened using a modified version of the Patient Health Questoinnaire-2 in the participant questionnaire.