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The Patient Health Questionnaire (PHQ-8) was conducted in 41 states and territories; it consisted of 8 questions based on the Statistical Manual of Psychiatric Disorders, Fourth Edition (DSM-IV) [24,25]. It was modified from a self-report paper format to a format compatible to telephone interview in order to be used in the 2006 BRFSS. The responders were asked to answer the questions on what they had experienced about emotions or behaviors related to depression during the past two weeks (Appendix 1). The total score for the PHQ-8 ranged from 0 to 14, which also meant the total number of days for a responder that might have experienced emotions or behaviors.
In order to separate varying levels of depression, the CDC developed three algorithms (Appendix 2). The total number of days was converted to a point scale ranging from 0 to 3 (0 = “0 to 1 day”, 1 = “2 to 6 days”, 2 = “7 to 11 days”, and 3 = “12 to 14 days”) . Depending on the algorithm used, the total points were used to determine whether the responders were depressed at the time they were interviewed.
Demographic characteristics, including age, sex, race/ ethnicity, height and weight, were obtained from the participants’ self-reports. Obesity was defined by BMI [weight (kg) / height2 (m2)] and was classified into three groups: non-overweight/ obese (BMI<25); overweight (25 BMI<30); obese (BMI 30). Previous studies indicated that self-reported height and weight were highly correlated with physical measurements [27,28], but self-reports tended to underestimate weight and overestimate height [28,29], resulting in lower estimates of overweight and obesity.