Depression is a persistent issue in Denver.
In 2017, one in eight residents of Denver County reported experiencing eight or more days of poor mental health in the past month. One in four pregnant Denverites experience symptoms of depression, and nearly a third of middle and high schoolers report having stretches of feeling persistently sad and hopeless. The city’s rate of suicide is consistently higher than the national rate.
“If there’s a family that hasn’t been affected by depression, I haven’t met them,” said Bill Burman, executive director of Denver Public Health and a professor at the University of Colorado School of Medicine.
Yet there has been surprisingly little evaluation that looks comprehensively at who’s affected by depression in Denver and what the Mile High City is doing – and can do – to address it.
Researchers at Denver Public Health set out to change that with their recent report, “Depression in Denver: Through the Lifespan,” which combines the input of community members and organizations and information from a range of data sources to provide insights into depression, how it manifests across the lifespan, and what people and institutions can do to address it.
One groundbreaking component of the report is data from a unique collaborative network that offers a glimpse into how depression is identified and treated in Denver’s health system. The Colorado Health Observation Regional Data Services (CHORDS) brings together data from health care and behavioral health providers’ electronic health records to help answer questions about the health of Coloradans.
“There are groups that are disproportionately affected,” said Burman, noting that depression is affected by social, economic, and environmental circumstances that can combine with stress, trauma, and other health issues. And yet, he said, at the local level, “as we look at important health problems, the lack of behavioral health data is striking.”
The most common way of gathering data about health issues like depression is through phone and online surveys, like the federal Behavioral Risk Factor Surveillance System or the Colorado Health Access Survey, or CHAS. While those surveys provide important information, they don’t describe how health systems are diagnosing issues; they also often can’t be analyzed at a neighborhood level. Some surveys don’t include all age groups, including children. Some ask more broadly about “poor mental health,” rather than specifically about depression.
CHORDS, on the other hand, allowed public health researchers to use data from electronic health records to gain an understanding of who health providers are actually diagnosing and treating for depression.
“It’s a valuable data source to bring in,” Burman said.
While CHORDS doesn’t include data from every health care provider in Denver, it includes some of the largest, including Denver Health and Hospital Authority, Kaiser Permanente Colorado, Children’s Hospital Colorado, and the Mental Health Center of Denver, and it is continuing to grow. All data from CHORDS are de-identified and aggregated to ensure patients’ privacy.
Looking Across Communities
Sarah Belstock, a behavioral health planner at Denver Public Health and an author of the report, said that the maps affirmed what other data sources suggested: “This is a health issue that impacts people across all our communities,” she said.
Eleven percent of adults had received a clinical diagnosis of depression in 2016, according to CHORDS. While that is somewhat lower than the frequency of depression reported on telephone surveys, researchers were not surprised: Some people may not share symptoms with a health care provider, whether due to stigma, lack of ability or desire to access care, or other factors.
The CHORDS data allowed the researchers to create maps that showed how common diagnoses of depression are in different neighborhoods. They found that unlike some health issues, which are clustered in lower-income neighborhoods, depression diagnoses are common across the city.
CHORDS data also allowed researchers to look at diagnoses among children. They found that depression diagnoses are more common in older children.
The report includes recommendations for community organizations, employers, community members, and health systems, informed in part by the CHORDS data, to ensure that the findings of the report lead to real change. For instance, the report suggests that health systems can adopt screening instruments and processes that are appropriate for men, people of color, LGBTQ populations, and women who are postpartum, while researchers can examine the interactions between drug and alcohol misuse and depression.
Belstock said she hopes the report is a step toward improving services and access to care. “This is an issue that can affect anyone and everyone,” Belstock said. “It’s exciting to pull back and see what everyone can do.”
For his part, Burman hopes that Denver Public Health and others will continue to use CHORDS to help improve understanding of issues beyond depression, including alcohol use, suicide, mental health challenges among men, and cannabis use.
“Let’s move into those spaces to provide data and understanding,” he said. “These are tools you can use now to help look at these problems that have always been important but are finally getting the attention they’ve needed forever.”
The Colorado Health Observation Regional Data Service (CHORDS) is gathering and aggregating electronic medical record data from health care and mental health providers on the Front Range in Colorado. For the first time, researchers and public health agencies have access to clinical data to help monitor public health trends. CHORDS partners providing technical support include University of Colorado Denver Adult and Child Consortium for Outcomes Research and Delivery Science (ACCORDS), Colorado Community Managed Care Network (CCMCN), and the Colorado Regional Health Information Organization (CORHIO).