Concept: Mood and Anxiety Disorders - Measuring Prevalence

Introduction

"Mood and anxiety disorders represent a broad spectrum of conditions that range from poor adjustment reactions and anxiety state to anxiety disorders, phobic disorders, obsessive-compulsive disorders, depressive disorders, affective psychoses, and neurotic depression (Doupe et al., 2008; Martens et al., 2004; Martens et al., 2010)". (Brownell et al., 2012).

NOTE: This concept reflects the current MCHP approach of combining depression and anxiety into one condition termed Mood and Anxiety Disorders. The existing concepts and definitions related to depression and anxiety are still available on our web site. Links to this information are available in the Related Concepts and Related Terms sections below.

MCHP Research Definitions for Mood and Anxiety Disorders Using ICD Codes and Prescription Drug Data

Over time, slight variations in the definition for mood and anxiety disorders have been used in MCHP research. The variations involve two specific considerations. The first involves the inclusion of ICD-10-CA code F45.2 - Hypochondriacal disorder. In some research, the algorithm requires the code only as a diagnosis, and in other research, the algorithm requires the code as a diagnosis plus a corresponding prescription for antidepressants or mood stabilizers. The second variation in the definition involves a change in the range of ATC codes, in conjunction with a diagnosis, that are required in order to be included as part of the definition.

DATA SOURCES:

In all of the following algorithms:


• hospitalization / hospital separation information is found in the Hospital Abstracts data;
  
• physician visit / physician claims information is found in the Medical Services (Physician Claims) data; and
  
• medication / prescription drug information is found in the Drug Program Information Network (DPIN) data.

1. Brownell et al. (2012, 2015, 2018, 2020), Smith et al. (2013), and Chartier et al. (2015)

In Brownell et al. (2012, 2015, 2018, 2020), Smith et al. (2013), and Chartier et al. (2015) an individual is considered to have a mood and anxiety disorder if they meet at least one of the following criteria within a five-year time period.


• one or more hospitalizations with a diagnosis for depressive disorder, affective psychoses, neurotic depression or adjustment reaction: ICD-9-CM codes 296.1-296.8, 300.4, 309 or 311; ICD-10-CA codes F31, F32, F33, F34.1, F38.0, F38.1, F41.2, F43.1, F43.2, F43.8, F53.0, F93.0
  
  
• one or more hospitalizations with a diagnosis for an anxiety state, phobic disorders or obsessive-compulsive disorders: ICD-9-CM codes 300.0, 300.2, 300.3, 300.7; ICD-10-CA codes F40, F41.0, F41.1, F41.3, F41.8, F41.9, F42, F45.2;
  
  NOTE: In Brownell et al. (2018) they investigated mood and anxiety disorders in children and of the mother. They also included ICD-10-CA codes F93.1 (Phobic anxiety disorder of childhood) and F93.2 (Social anxiety disorder of childhood) in their definition of mood and anxiety disorders in children.
  
  
• one or more hospitalizations with a diagnosis for anxiety disorders: ICD-9-CM code 300; ICD-10-CA codes F32, F34.1, F40, F41, F42, F44, F45.0, F45.1, F45.2, F48, F68.0, or F99 AND one or more prescriptions for an antidepressant or mood stabilizer, including medications with the ATC codes N05AN01, N05BA, N06A. Note: See the medication list below for a complete set of medications used in Brownell et al. (2012).;
  
  
• one or more physician visits with a diagnosis for depressive disorder or affective psychoses: ICD-9-CM codes 296, 311;
  
  
• one or more physician visits with a diagnosis for anxiety disorders: ICD-9-CM code 300 AND one or more prescriptions for an antidepressant or mood stabilizer, including medications with the ATC codes N05AN01, N05BA, N06A. Note: See the medication list below for a complete set of medications used in Brownell et al. (2012).
  
  
• three or more physician visits with a diagnosis for anxiety disorders or adjustment reaction: ICD-9-CM code 300, 309

Age Restrictions:

In Brownell et al. (2015), mood and anxiety disorders were one component of a mental disorders condition that was being investigated for children. The definition was restricted to children aged 10 and older. In Brownell et al. (2018), the definition was restricted to children age 3 and older.

Medications Related to Mood and Anxiety Disorders

• In Brownell et al. (2012), the Mood and Anxiety medication list is based on the currently available ATC codes and Drug Identification Numbers (DINs) for these conditions.

Measuring Prevalence

In Brownell et al. (2012), the prevalence of Mood and Anxiety Disorders was measured in 2-year time periods over a 10-year period, for two different scenarios:


1. the prevalence of children aged 0-19 years living with a mother who has been treated for a mood and anxiety disorder; and
   
2. the prevalence of children aged 13-19 who have been treated for a mood and anxiety disorder.

For more information, please see the section Children Living with a Mother with Mood and/or Anxiety Disorders in Brownell et al. (2012).

In Smith et al. (2013), the prevalence of Mood and Anxiety Disorders was measured over five years for residents aged 10 and older. For more information, please see the section Mood and Anxiety Disorders in Smith et al. (2013).

In Chartier et al. (2015) they investigated the prevalence and relative risk of mood and anxiety disorders as a comorbidity to chronic kidney disease (CKD) and end stage kidney disease (ESKD) in both adults and children (aged 10-17 years old). For more information, please read:


• Table 4.2: Mental Disorders in Adults in End Stage Kidney Disease Patient Cohorts;
  
• Table 4.6: Mental Disorders in Adults in Chronic Kidney Disease Patient Cohorts; and
  
• Table 5.2: Mental Disorders in Children in Patient Cohorts

2. Katz et al. (2013) and Ruth et al. (2015)

In the Understanding the Health System Use of Ambulatory Care Patients deliverable by Katz et al. (2013), they investigated the patterns of ambulatory care services (see Ambulatory Visits - Physician) delivered by primary care and specialist physicians to Manitobans with one of six chronic conditions. This study focused on Manitobans aged 19 and older over a three-year period (plus one-year follow-up) and measured how these patterns of care impact on the quality of care received. Mood and anxiety disorders, one of the six chronic conditions investigated, were identified by using the definitions described below. Note: due to the time frame of the study, only ICD-10-CA coding was used to identify mood and anxiety disorders from the hospital data.

In the deliverable Long-Term Outcomes Of Manitoba's Insight Mentoring Program: A Comparative Statistical Analysis by Ruth et al. (2015), they defined cases of Mood and Anxiety Disorders using both ICD-9-CM and ICD-10-CA coding from the hospital data.

The definitions for mood and anxiety disorders included:


• one hospital diagnosis: mood disorders (ICD-9-CM codes: 296.1-296.8; ICD-10-CA codes: F36, F33, F38, F38.1), stress and adjustment disorders (ICD-9-CM codes: 300.4, 309, 311; ICD-10-CA codes: F43, F43.2, F43.8), mental and behavioural disorders (no corresponding ICD-9-CM codes; ICD-10-CA codes: F53), emotional disorders (no corresponding ICD-9-CM codes; ICD-10-CA codes: F93) in three years; OR
  
  
• three ambulatory visit diagnoses: mood disorders (ICD-9-CM codes: 296), reaction to stress and adjustment disorders (ICD-9-CM codes: 309), depressive disorders (ICD-9-CM codes: 311) in three years; OR
  
  
• one hospital diagnosis: anxiety disorders (ICD-9-CM codes: 300.0; ICD-10-CA codes: F40, F41, F41.1), depressive disorders (no corresponding ICD-9-CM codes; ICD-10-CA code: F32), mood disorders (no corresponding ICD-9-CM codes; ICD-10-CA code: F34.1), obsessive-compulsive disorders (no corresponding ICD-9-CM codes; ICD-10-CA code: F42), dissociative disorders (no corresponding ICD-9-CM codes; ICD-10-CA code: F44), somatoform disorders (no corresponding ICD-9-CM codes; ICD-10-CA codes: F45.0, F45.1) in three years AND at least one prescription for antidepressants and mood stabilizers (ATC codes: N03AB02, N03AB52, N03AF01, N06A) in three years; OR
  
  
• three ambulatory visit diagnoses: anxiety disorders (ICD-9-CM code: 300) in three years AND at least one prescription for antidepressants and mood stabilizers (ATC codes: N03AB02, N03AB52, N03AF01, N06A) in three years.

Research Findings

In Katz et al. (2013), a "Mood Disorders" cohort was developed based on the algorithm above, and physician visits of this group were analyzed. For more information on the results of this research, see the section Mood Disorders Cohort in the on-line deliverable.

In Ruth et al. (2015), they used the diagnosis of mood and anxiety disorder as a health status outcome before, during and after for participants enrolled in the Insight Mentoring Program. For more information on the results of this research, including unadjusted rates of mental health indicators and unadjusted relative risks for mental health indicators, see the section Diagnosis of a Mood or Anxiety Disorder in the on-line deliverable.

3. Fransoo et al. (2013)

In Fransoo et al. (2013), they defined mood and anxiety disorders prevalence as the percent of residents aged 10 and older with mood and anxiety disorders over two 5-year periods. Mood and anxiety disorders include depression; episodic mood disorders (bipolar disorder, manic episode); anxiety (anxiety disorders, phobic disorders, obsessive-compulsive disorders); dissociative and somatoform disorders; or adjustment reaction as defined by:


• at least one hospitalization with an ICD-9-CM code of 296.1-296.8, 300.0, 300.2-300.4, 300.7, 309, 311 or an ICD-10-CA code of F31, F32, F33, F34.1, F38.0, F38.1, F40, F41.0-F41.3, F41.8, F41.9, F42, F43.1, F43.2, F43.8, F45.2, F53.0, F93.0; OR
  
  
• at least one physician visit with an ICD-9-CM code of 296 or 311; OR
  
  
• at least one hospitalization or physician visit with an ICD-9-CM code of 300 or an ICD-10-CA code of F41, F44, F45.0, F45.1, F48, F68.0, F99 and at least one prescription for mood and anxiety medications (ATC codes N05AN01, N05BA, N06A); OR
  
  
• at least three physician visits with an ICD-9-CM code of 300 or 309

Prevalence was calculated for 2002/03-2006/07 and 2007/08-2011/12 and was age- and sex-adjusted for the Manitoba population aged 10 and older.

Further Information

For more information on mood and anxiety disorders prevalence, including key findings, comparison to other findings and graphs by different geographical areas, please see Section 5.1 Mood and Anxiety Disorders Prevalence in Fransoo et al. (2013).

4. Martens et al. (2015)

In The Cost of Smoking: A Manitoba Study deliverable by Martens et al. (2015) they calculated the weighted crude prevalence of mood and anxiety disorders two ways; one using administrative data and the other using self-reported survey data. Using the administrative data, the weighted crude prevalence of mood and anxiety disorders was calculated for survey respondents aged 12 and older in the five years before their survey date. Mood and anxiety disorders were defined by one of the following conditions:


• one or more hospitalizations with a diagnosis of depression, episodic mood disorders (e.g., bipolar disorder, manic episode) or anxiety (e.g., anxiety disorders, phobic disorders, obsessive-compulsive disorders), ICD-9-CM codes 296.1–296.8, 300.0, 300.2–300.4, 300.7, 309, 311; ICD-10-CA codes F31, F32, F33, F34.1, F38.0, F38.1, F40, F41.0–F41.3, F41.8, F41.9, F42, F43.1, F43.2, F43.8, F45.2, F53.0, F93.0;
  
  
• one or more physician visits with a diagnosis of depression or episodic mood disorders, ICD-9-CM codes 296 and 311;
  
  
• one or more hospitalizations or physician visits with a diagnosis of anxiety, dissociative and somatoform disorders, ICD-9-CM code 300; ICD-10-CA codes F32, F34.1, F40, F41, F42, F44, F45.0, F45.1, F48, F68.0, F99 and one or more prescriptions for an antidepressant (e.g., fluoxetine, citalopram, desipramine, venlafaxine), benzodiazepine derivatives anxiolytics (e.g., diazepam), or lithium (an antipsychotic), ATC codes N05AN01, N05BA, N06A; or
  
  
• three or more physician visits with a diagnosis of anxiety, dissociative and somatoform disorders or adjustment reaction, ICD-9-CM codes 300 and 309.

Using survey data, a different method for identifying mood and anxiety disorders was required. Since the Drug Program Information Network (DPIN) data were not available for respondents of the Manitoba Heart Health Survey (MHHS), only the first, second, and fourth conditions of the algorithm above were used to calculate prevalence for MHHS respondents. In the Canadian Community Health Survey (CCHS) data, questions about mood and anxiety disorders were asked in the CCHS 3.1 (2005) and onward. Respondents were asked, "Do you have a mood disorder such as depression, bipolar disorder, mania or dysthymia?" Possible responses include "yes", "no" or "don’t know". They were then also asked, "Do you have an anxiety disorder such as a phobia, obsessive-compulsive disorder or a panic disorder?" Possible responses include "yes", "no" or "don't know". The weighted crude self-reported prevalence of mood and anxiety disorders was calculated for survey respondents aged 12 and older as the percentage of respondents who answered "yes" out of all respondents who gave a valid answer. Respondents who answered "don't know" and those with missing or invalid data were excluded from the prevalence calculation.

For more information on the prevalence rates of mood and anxiety disorders from survey (self-reported) and administrative data from The Cost of Smoking: A Manitoba Study deliverable, see Table 4.8 Chronic Diseases of Estimated-Population-Based Sample* at Time of Survey by Smoking Status Categories in Martens et al. (2015).

5. Chartier et al. (2016)

In The Mental Health of Manitoba's Children deliverable by Chartier et al., 2016, they defined mood and anxiety disorders for children aged 6 to 19 years, using the following algorithm:


• 1 or more hospitalizations with one of the following diagnosis codes -- ICD-9: 296.1-296.8, 300.0, 300.2, 300.3, 300.4, 300.7, 309 or 311; ICD-10: F31-F33, F34.1, F38.0, F38.1, F40, F41.0, F41.1, F41.2, F41.3, F41.8, F41.9, F42, F43.1, F43.2, F43.8, F53.0, or F93.0; OR
  
  
• 1 or more hospitalizations with one of the following diagnosis codes -- ICD-9: 300; ICD-10: F32, F34.1, F40, F41, F42, F44, F45.0, F45.1, F45.2, F48, F68.0 or F99 AND one or more prescriptions for an antidepressant or mood stabilizer: ATC codes N05AN01, N05BA, N06A, N05BE01; OR
  
  
• 1 or more physician visits with one of the following diagnosis codes -- ICD-9: 296, 311; OR
  
  
• 1 or more physician visits with the following diagnosis code -- ICD-9: 300 AND one or more prescriptions for an antidepressant or mood stabilizer: ATC codes N05AN01, N05BA, N06A, N05BE01; OR
  
  
• 3 or more physician visits with one of the following diagnosis codes -- ICD-9: 300, 309.

Research Findings

In this research, diagnostic prevalence of mood and anxiety disorders was calculated for two different time periods: 2005/06-2008/09 and 2009/10-2012/13. The research findings are illustrated and discussed by Health Region, Winnipeg Community Area, age groupings and sex, and income quintile. For more information, see the section titled Mood and Anxiety Disorders in the on-line deliverable.

6. Chartier et al. (2018)

In The Mental Illness Among Adult Manitobans deliverable by Chartier et al., 2018, the following ICD codes were used to define mood and anxiety disorders in this research included:


• one or more hospitalizations with a diagnosis for depressive disorder, affective psychoses, neurotic depression, adjustment reaction, bipolar disorder, an anxiety state, phobic disorders or obsessive-compulsive disorders: ICD-9-CM codes: 296, 311, 309, 300 or ICD-10 CA codes F30, F31, F32, F33, F34, F38, F40, F41, F41.1, F41.2, F41.3, F41.8, F41.9, F42, F43, F53; OR
  
  
• two or more physician visits with a diagnosis for depressive disorder or affective psychoses, adjustment reaction or for anxiety disorders (including dissociative and somatoform disorders): ICD-9-CM codes 296, 311, 309, 300.

Research Findings

In this research, diagnostic prevalence of mood and anxiety disorders was calculated for two different time periods: 2010/11-2014/15. The research findings are illustrated and discussed by Health Region, Health Region District, Winnipeg Neigbourhood Cluster, age and sex, and income quintile. For more information, see the section titled Mood and Anxiety Disorders in the on-line deliverable.

7. Fransoo et al. (2019)

In The 2019 RHA Indicators Atlas deliverable by Fransoo et al. (2019), the following ICD codes, medications and conditions were used to define mood and anxiety disorders:


• one or more hospitalizations with a diagnosis of depression, episodic mood disorders (i.e., bipolar disorder, manic episode), or anxiety (i.e., anxiety disorders, phobic disorders, obsessive–compulsive disorders): ICD–9–CM codes 296.1–296.8, 300.0, 300.2–300.4, 300.7, 309, 311; ICD–10–CA codes F31, F32, F33, F34.1, F38.0, F38.1, F40, F41.0–F41.3, F41.8, F41.9, F42, F43.1, F43.2, F43.8, F45.2, F53.0, F93.0
  
• one or more physician visits with a diagnosis of depression or episodic mood disorders: ICD–9–CM codes 296 and 311.
  
• one or more hospitalizations or physician visits with a diagnosis of anxiety, dissociative, and somatoform disorders: ICD–9–CM code 300; ICD–10–CA codes F32, F34.1, F40, F41, F42, F44, F45.0, F45.1, F48, F68.0, F99 AND one or more dispensations of an antidepressant (i.e., fluoxetine, citalopram, desipramine, venlafaxine), benzodiazepine derivatives anxiolytics (i.e., diazepam), or lithium (an antipsychotic)): ATC codes N05AN01, N05BA, N06A
  
• three or more physician visits with a diagnosis of anxiety, dissociative, and somatoform disorders or adjustment reaction, ICD–9–CM codes 300 and 309.

Research Findings

As part of the work for this Atlas, the Community Health Assessment Network (CHAN) requested 20-year time trend analyses on a number of key indicators from past Atlas reports. One of those was the prevalence of mood and anxiety disorders. The research reported on the age- and sex-adjusted prevalence of mood and anxiety disorders for residents age 10 and older in four five-year time periods from 1997/98-2001/02 to 2012/13-2016/17.

For more information on the findings from this research, see Appendix 2: 20-Year Time Trend Analysis of Prevalence of Mood and Anxiety Disorders.

Cautions and Limitations

The following cautions and limitations should be considered when investigating Mood and Anxiety Disorders:


• If looking at a 1-year period prevalence, it is strongly recommended that more than one physician visit with a diagnosis code of 300 and 309 be recorded in order for a patient to be considered as having a mood and anxiety disorder.
  
  
• The conditions in this group are often difficult to distinguish in administrative data because of variations in clinical presentations, coding practices, screening, and diagnostic tools. The majority of patients are identified as having a mood and anxiety disorder based on physician visits (claims), which are limited to three-digit diagnostic codes. Conditions such as depression and anxiety require coding to the four-digit level and these can only be found in hospital data. However, fewer individuals are hospitalized with a diagnosis of mood and anxiety disorders. (Martens et al., 2004).
  
  
• While the use of pharmaceutical information can distinguish between antidepressant and mood stabilizer drugs, the use of these drugs may not be specific to a single condition (Martens et al., 2004).
  
  
• Measuring the prevalence of mood and anxiety disorders represents treatment of the condition; thus, those suffering from these disorders but not treated by their physicians will not be captured in the administrative data (Martens et al., 2004).
  
  
• It is difficult to identify and validate mood and anxiety disorders in children younger than 10 years of age (Martens et al., 2004).