Assessing availability of depression severity indicators in electronic health record data: A retrospective study in two large academic health care systems in the United States.

Abstract

The high prevalence of major depressive disorder (MDD) combined with low treatment response supports continued research in this area. Electronic health records (EHR) are an important real-world data source for such MDD research, yet indicators of depression severity, a key confounder, are unreliably available. We examined the availability of depression severity indicators in the EHR and identified patient characteristics associated with having a severity indicator available for patients with an MDD diagnosis. We leveraged EHR data from academic health systems in Colorado and Utah from 2016 to 2021 to calculate the proportion of MDD encounters with a severity indicator from two sources in the EHR (diagnosis codes and Patient Health Questionnaire-9 total scores). We compared characteristics between patients with and without severity indicators using chi-square and t tests. We also estimated the proportional agreement between the two sources of severity. Among 1.55 million encounters with an MDD diagnosis from 2016 to 2021, 38% had a severity indicator available from the diagnosis code or Patient Health Questionnaire-9 total score. Availability increased from 28% in 2016 to 47% in 2021. Overall agreement was low at the MDD encounter level. Hispanic patients and those with anxiety, bipolar disorder, posttraumatic stress disorder, attention-deficit/hyperactivity disorder, and substance use disorder were more likely to have a severity indicator. While availability of depression severity in EHR data is increasing, it remains low. Researchers wanting to use depression severity data from the EHR should be cognizant of the potential impact of missing severity on their research and be cautious about using diagnosis codes and Patient Health Questionnaire-9 scores as indicators of severity in isolation. (PsycInfo Database Record (c) 2025 APA, all rights reserved).