Table 1.
Characteristics of mental health specialty visits for development sample (January 1, 2009 – September 30, 2014) and prospective validation sample (January 1, 2015—September 30, 2017)
| Characteristic | Development dataset (N = 9,610,318 visits) | Prospective validation dataset (N = 3,754,137 visits) | ||
|---|---|---|---|---|
| N | % | N | % | |
| Female | 6,081,526 | 64.1 | 2,406,695 | 64.1 |
| Age | ||||
| 17 or younger | 1,048,533 | 10.9 | 417,977 | 11.1 |
| 18–29 | 1,562,616 | 16.3 | 670,337 | 17.9 |
| 30–44 | 2,453,898 | 25.5 | 948,716 | 25.3 |
| 45–64 | 3,510,438 | 36.5 | 1,242,067 | 33.1 |
| 65 or older | 1,034,813 | 10.8 | 475,040 | 12.7 |
| Race | ||||
| White | 6,627,544 | 69.0 | 2,511,547 | 66.9 |
| Asian | 448,590 | 4.7 | 192,284 | 5.1 |
| Black | 836,479 | 8.7 | 324,852 | 8.7 |
| Hawaiian/Pacific Islander | 108,410 | 1.1 | 32,803 | 0.9 |
| Native American | 92,312 | 1.0 | 35,824 | 1.0 |
| More than one | 3,298 | 0.03 | 1,788 | 0.1 |
| Other race recorded | 48,800 | 0.5 | 20,879 | 0.6 |
| Not race recorded | 1,444,885 | 15.0 | 634,160 | 16.7 |
| Ethnicity | ||||
| Hispanic | 2,183,742 | 22.7 | 987,061 | 26.3 |
| Insurance type | ||||
| Commercial group | 7,275,199 | 75.7 | 2,544,926 | 67.8 |
| Individual | 325,139 | 3.4 | 141,234 | 3.8 |
| Medicare | 1,409,742 | 14.7 | 572,476 | 15.2 |
| Medicaid | 406,606 | 4.2 | 413,007 | 11.0 |
| Other | 193,632 | 2.0 | 82,494 | 2.2 |
| PHQ-9 9th item response1 | ||||
| 0, Not at all | 590,468 | 6.1 | 743,288 | 19.8 |
| 1, Several days | 121,483 | 1.3 | 153,671 | 4.1 |
| 2, More than half the days | 43,697 | 0.5 | 46,977 | 1.3 |
| 3, Nearly every day | 31,408 | 0.3 | 32,410 | 0.9 |
| Not recorded | 8,823,262 | 91.8 | 2,777,791 | 74.0 |
| PHQ-9 recorded in the previous year | 1,296,856 | 13.5 | 1,623,943 | 43.3 |
| Diagnoses in past 5 years, including index visit | ||||
| Depression | 7,257,525 | 75.5 | 2,852,694 | 76.0 |
| Anxiety | 6,734,366 | 70.1 | 2,967,524 | 79.0 |
| Bipolar depression | 1,317,629 | 13.7 | 474,897 | 12.6 |
| Schizophrenia | 400,713 | 4.2 | 154,590 | 4.1 |
| Other psychosis | 537,050 | 5.6 | 221,351 | 5.9 |
| Dementia | 96,751 | 1.0 | 54,782 | 1.5 |
| Attention deficit disorder | 1,151,179 | 12.0 | 485,877 | 12.9 |
| Autism spectrum disorder | 131,900 | 1.4 | 65,795 | 1.8 |
| Personality disorder | 1,961,027 | 20.4 | 603,400 | 16.1 |
| Alcohol use disorder | 1,561,302 | 16.2 | 553,027 | 14.7 |
| Drug use | 1,654,129 | 17.2 | 588,481 | 15.7 |
| Post-traumatic stress disorder | 845,842 | 8.8 | 400,959 | 10.7 |
| Eating disorder | 350,320 | 3.6 | 144,204 | 3.8 |
| Traumatic brain injury | 312,516 | 3.3 | 140,940 | 3.8 |
| Prescription fills in past 5 years | ||||
| Antidepressants | 6,521,196 | 67.9 | 2,559,147 | 68.2 |
| Benzodiazepines | 4,536,960 | 47.2 | 1,641,900 | 43.7 |
| Hypnotics | 1,427,849 | 14.9 | 381,353 | 10.2 |
| 2nd generation antipsychotics | 2,035,084 | 21.2 | 799,401 | 21.3 |
| Encounters in prior 5 years with mental health diagnosis | ||||
| Inpatient | 2,296,579 | 23.9 | 859,640 | 22.9 |
| Outpatient | 8,789,642 | 91.5 | 3,431,776 | 91.4 |
| Emergency department | 3,167,119 | 33.0 | 1,347,840 | 35.9 |
| Suicide attempt in prior 5 years | 381,591 | 4.0 | 172,329 | 4.6 |
| Charlson comorbidity index | ||||
| 0 | 7,133,017 | 74.2 | 2,719,729 | 72.4 |
| 1 | 1,402,435 | 14.6 | 565,038 | 15.1 |
| > 1 | 1,074,866 | 11.2 | 469,370 | 12.5 |
| Suicide death within 90 days of visit | 2318 | 24 per 100,000 | 710 | 19 per 100,000 |
1The PHQ-9 9th item asks patients about the frequency of thoughts of suicide or death in the prior 2 weeks