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J Public Health Manag Pract. 2018 Nov/Dec;24(6):E6-E14. doi: 10.1097/PHH.0000000000000751.

Monitoring Depression Rates in an Urban Community: Use of Electronic Health Records.

Author information

Denver Public Health, Denver Health, Denver, Colorado (Dr Davidson and Ms McCormick); Department of Medicine, Denver Health, Denver, Colorado (Dr Havranek); Health Services Research, Denver Health, Denver, Colorado (Mr Durfee); Kaiser Permanente Colorado, Institute for Health Research, Denver, Colorado (Drs Xu, Steiner, and Beck); and Department of Medicine, University of Rochester Medical Center, Rochester, New York (Dr Oronce).



Depression is the most common mental health disorder and mediates outcomes for many chronic diseases. Ability to accurately identify and monitor this condition, at the local level, is often limited to estimates from national surveys. This study sought to compare and validate electronic health record (EHR)-based depression surveillance with multiple data sources for more granular demographic subgroup and subcounty measurements.


A survey compared data sources for the ability to provide subcounty (eg, census tract [CT]) depression prevalence estimates. Using 2011-2012 EHR data from 2 large health care providers, and American Community Survey data, depression rates were estimated by CT for Denver County, Colorado. Sociodemographic and geographic (residence) attributes were analyzed and described. Spatial analysis assessed for clusters of higher or lower depression prevalence.


Depression prevalence estimates by CT.


National and local survey-based depression prevalence estimates ranged from 7% to 17% but were limited to county level. Electronic health record data provided subcounty depression prevalence estimates by sociodemographic and geographic groups (CT range: 5%-20%). Overall depression prevalence was 13%; rates were higher for women (16% vs men 9%), whites (16%), and increased with age and homeless patients (18%). Areas of higher and lower EHR-based, depression prevalence were identified.


Electronic health record-based depression prevalence varied by CT, gender, race/ethnicity, age, and living status. Electronic health record-based surveillance complements traditional methods with greater timeliness and granularity. Validation through subcounty-level qualitative or survey approaches should assess accuracy and address concerns about EHR selection bias. Public health agencies should consider the opportunity and evaluate EHR system data as a surveillance tool to estimate subcounty chronic disease prevalence.

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