Transcript: Excess Service Use by Those Not Clinically Classified as Depressed

The so-called “prevention paradox” has also been found in research on other population health issues. This graph depicts data from a 1985 study by Brenner. It portrays the distribution of symptoms of depression and mental health services.

In Brenner’s study, participants were asked to complete an inventory of depression.Each item corresponded to a sign of depression such as sleep disturbances (e.g., waking up early). The more items a person reported, the more likely the person was deemed to be depressed. The bars in the figure illustrate the incidence of people who reported various numbers of depression symptoms. By convention, reporting 6 or more items indicates that a person is depressed to the point where treatment is needed.

Brenner wanted to know whether having a sub-clinical (i.e., less severe) case of depression was related to excess use of mental health services/supports.

The excess use of services/supports above the rate for no depressive symptoms is shown by the broken line.

The excess use of services/supports tended to go up as the number of depressive symptoms increased. So, it would appear that those who reported three symptoms of depression were functionally worse off than those who endorsed two symptoms of depression, even though neither are close to being clinically diagnosed with depression.

The numbers on top of the bars show the proportion of the total excess service/support use attributable to different levels of depression. As such, only 24% of the excess service use occurred among people who were deemed to be clinically depressed (i.e., 6+ symptoms). Thus the majority of excess service use occurred among people who were not clinically depressed – those who were at lower risk.