Executive Client Partner Cerner Enviza Kansas City, United States
Background: According to the World Health Organization, the global prevalence of depression increased by 25% in the first year of the COVID-19 pandemic. To address the needs for mental health services, it is imperative to understand the prevalence of those who may have depression but are unscreened and undiagnosed.
Objectives: To compare rates of diagnosed depression and undiagnosed major depressive syndrome (MDS) among adults in the US from pre-COVID-19 to post COVID-19 pandemic years.
Methods: Data from the 2011 (N=75,000), 2019 (N=74,994), and 2022 (N=75,261) US National Health and Wellness Survey, a nationally-representative, cross-sectional online survey of adults (aged ≥18), were analyzed. Respondents were classified as having depression if they self-reported having a physician diagnosis of depression. Among those who did not self-report having depression, respondents were categorized as having undiagnosed MDS via the Patient Health Questionnaire 9-item depression module (PHQ-9) if ≥ 5 of the 9 depressive symptom criteria were present at least “more than half the days” in the past 2 weeks, and if 1 of the symptoms was depressed mood or anhedonia. Those with a self-reported diagnosis of bipolar or who screened positive for bipolar were excluded. Additionally, PHQ-9 assessed severity ranging from 0 to 27. Descriptive statistics were conducted.
Results: The prevalence of diagnosed depression with MDS in pre-COVID-19 years (2011 and 2019) was 3.2% (n=2,425) and 4.0% (n=2,989), respectively. Among those who were diagnosed with depression in the 2011 and 2019 results, 2.1% (n=1,583) and 2.4% (n=1,792) were receiving a prescription treatment. Post-COVID-19 (2022), 3.4% (n=2,568) of respondents reported being diagnosed with depression and MDS; 2.1% of whom were receiving treatment. The prevalence of no self-reported depression but having MDS in 2011 was 2.3% (n=1,719), which increased to 5.2% (n=3,932) in 2019. In 2022, the prevalence was 11.9% (n=8,985), which was 5 times the prevalence of 2011 and twice the prevalence in 2019. In 2022, among those with undiagnosed MDS, 16% had moderate depression, 38% had moderate-severe depression, and 46% had severe depression.
Conclusions: While the prevalence of diagnosed depression and treatment are similar from pre-COVID-19 to post COVID-19, the prevalence of undiagnosed MDS post-COVID-19 increased more than two-fold from one-year prior to COVID-19, and five-fold from more than 10 years ago. These results reveal the rise in underscreening for depression post COVID-19. Study findings help quantify the extent of the underdiagnosis problem for depression in the US. In the wake of the COVID-19 pandemic, access to mental health support and therapists are needed more than ever.
