Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2022 Aug;37(11):2736-2743.
doi: 10.1007/s11606-021-06957-5. Epub 2021 Aug 17.

Importance of Social Determinants in Screening for Depression

Robert M Califf  1 , Celeste Wong  2 , P Murali Doraiswamy  3 , David S Hong  4 , David P Miller  2 , Jessica L Mega  2 ; Baseline Study Group
Affiliations

Importance of Social Determinants in Screening for Depression

Robert M Califf et al. J Gen Intern Med. 2022 Aug.

Abstract

Importance: The most common screening tool for depression is the Patient Health Questionnaire-9 (PHQ-9). Despite extensive research on the clinical and behavioral implications of the PHQ-9, data are limited on the relationship between PHQ-9 scores and social determinants of health and disease.

Objective: To assess the relationship between the PHQ-9 at intake and other measurements intended to assess social determinants of health.

Design, setting, and participants: Cross-sectional analyses of 2502 participants from the Baseline Health Study (BHS), a prospective cohort of adults selected to represent major demographic groups in the US; participants underwent deep phenotyping on demographic, socioeconomic, clinical, laboratory, functional, and imaging findings.

Interventions: None.

Main outcomes and measures: Cross-sectional measures of clinical and socioeconomic status (SES).

Results: In addition to a host of clinical and biological factors, higher PHQ-9 scores were associated with female sex, younger participants, people of color, and Hispanic ethnicity. Multiple measures of low SES, including less education, being unmarried, not currently working, and lack of insurance, were also associated with higher PHQ-9 scores across the entire spectrum of PHQ-9 scores. A summative score of SES, which was the 6th most predictive factor, was associated with higher PHQ-9 score after adjusting for 150 clinical, lab testing, and symptomatic characteristics.

Conclusions and relevance: Our findings underscore that depression should be considered a comorbidity when social determinants of health are addressed, and both elements should be considered when designing appropriate interventions.

Keywords: Patient Health Questionnaire-9; effective clinical intervention; measures of health and disease.

PubMed Disclaimer

Conflict of interest statement

Califf: Employee of Verily Life Sciences and Google Health; Board member for Cytokinetics, United Medicines, and Clinetic.

Wong: Employee of Verily Life Sciences.

Doraiswamy: Consulting fees from Verily Life Sciences, Neuronix, Cognoptix, Anthrotronix, Genomind, Apollo Health, NeuroPro, Janssen, VitaKey, Neuroglee, Transposon; Research grants from Avanir, Lilly, NIH, DOD, DARPA, ONR, CAF; Holds stock in Anthrotronix, Turtle Shell Tech, Evidation, Advera Health Analytics, NeuroPro, Marvel Biome.

Hong: Research funding from NIMH; Consulting for Little Otter.

Miller: Employee of and holds stock in Verily Life Sciences.

Mega: Employee of Verily Life Sciences.

Figures

Fig. 1
Fig. 1
Factors associated with PHQ-9 score in linear model. SES was in the top six predictors of PHQ-9 score, significantly predicting higher PHQ-9 after adjusting for demographics, behavior, medical conditions, symptoms, and physical function (p<0.001). LASSO, least absolute shrinkage and selection operator; PHQ-9, Patient Health Questionnaire-9; SES, socioeconomic status.
Fig. 2
Fig. 2
Network depicting relationship of PHQ-9 and SES with selected variables. This figure demonstrates the relationships among PHQ-9, SES, and other key measures in a partial correlation network. The length of the edges is inversely proportional to the magnitude of the correlation, and hence, highly related nodes appear closer together, with thicker edges indicating stronger correlations. PHQ-9, Patient Health Questionnaire-9; SES, socioeconomic status.
See this image and copyright information in PMC

References

    1. GBD 2017 Disease and Injury Incidence and Prevalence Collaborators Global, regional, and national incidence, prevalence, and years lived with disability for 354 diseases and injuries for 195 countries and territories, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet. 2018;392(10159):1789–1858. doi: 10.1016/S0140-6736(18)32279-7. - DOI - PMC - PubMed
    1. DeSalvo KB, Wang YC, Harris A, Auerbach J, Koo D, O’Carroll P. Public health 3.0: a call to action for public health to meet the challenges of the 21st century. Prev Chroni Dis. 2017;14:E78. doi: 10.5888/pcd14.170017. - DOI - PMC - PubMed
    1. Perry PJ. The Interaction of Major Depression and Medical Illness. Medscape; 2005. Available at: https://www.medscape.org/viewarticle/517033. Accessed 2 May 2021.
    1. Ridley M, Rao G, Schilbach F, Patel V. Poverty, depression, and anxiety: causal evidence and mechanisms. Science. 2020;370(6522):eaay0214. doi: 10.1126/science.aay0214. - DOI - PubMed
    1. Kroenke K, Spitzer RL, Williams JB. The PHQ-9: validity of a brief depression severity measure. J Gen Intern Med. 2001;16(9):606–613. doi: 10.1046/j.1525-1497.2001.016009606.x. - DOI - PMC - PubMed

Publication types