Open Access Research article

A population-based cross-sectional study of health service deficits among U.S. adults with depressive symptoms

Krista L Huot1, May Nawal Lutfiyya23*, Michael F Akers3, Maria L Amaro3, Michael T Swanoski3 and Sarah K Schweiss3

Author Affiliations

1 Essentia Health System, Ambulatory Care Pharmacy Services, Duluth, MN 55805, USA

2 Essentia Institute of Rural Health, Duluth, MN 55803, USA

3 University of Minnesota, College of Pharmacy, Ambulatory Care Residency Program, Minneapolis, MN 55455, USA

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BMC Health Services Research 2013, 13:160  doi:10.1186/1472-6963-13-160

Published: 1 May 2013



Depression is a psychiatric condition that affects approximately one in five U.S. adults in their lifetime. No study that we know of has examined depressive symptoms and health service deficits in rural compared with non-rural populations. Four factors constitute the variable health service deficits: did not have health insurance, did not have a healthcare provider, deferred medical care because of cost and did not have a routine medical exam, all within the last 12 months. The aim of this study was to ascertain the prevalence of health service deficits in rural versus non-rural adults with depressive symptoms. Examining depressive symptoms by health service deficits is important because it allows us to approximate those with the condition who might not be receiving care for it. By analyzing national, population-based data, this study sought to fill in some important epidemiological gaps regarding depressive symptoms and health service deficits.


For this analysis the population of interest was U.S. adults identified as currently having depressive symptoms using the PHQ-8 criteria. Behavior Risk Factor Surveillance Survey 2006 data were used in this analysis. Health service deficits was the primary dependent variable. Multivariate logistic regression analysis was performed to examine health service deficits experienced by adults with depression controlling for socioeconomic status, race and ethnicity and geographic locale (rural or non-rural).


Logistic regression analysis yielded that U.S. adults currently having depressive symptoms who were of low socioeconomic status, Hispanic ethnicity, or living in a rural locale were more likely to have at least one health service deficit.


Analyzing data collected by a large surveillance system such as BRFSS, allows for an analysis incorporating an array of covariates not available from clinically-based data such as electronic health records. By identifying clinically depressed U.S. adults who also have at least one health service deficit, we were able to ascertain those most likely not receiving care for this debilitating condition. We believe community pharmacists are well suited to assist in connecting depressed, vulnerable populations with appropriate and needed care. This care would be best provided by an inter-professional team led by a primary care provider.

Health service deficits; Depression; BRFSS; Pharmacy practice