Mothers and Primary Care Medicine: In Reply

Abstract

In Reply.—Depression is a debilitating but often invisible disease. The World Health Organization predicts that by the year 2020,1 depression will be the largest worldwide burden of disease, second only to ischemic heart disease. Given its prevalence, all primary care providers, even pediatricians, should be willing to screen for depression among both children and adults and be prepared to refer patients for additional treatment. The US Preventive Services Task Force2 has recommended 2 simple questions for depression screening among adults that could be implemented in a pediatric health care visit. Because pediatricians often have a long-term and trusting relationship with their patients' parents, I view this setting as an ideal place for depression screening to occur.Simply having a relationship with an adult provider is not the answer to depression screening and treatment, as suggested by Dr Reingold. I have such a relationship, as I noted in my commentary, but it was not my provider who screened or treated me. A once-yearly visit is not the ideal location for depression screening, because depression can occur at any time, and waiting another 11 months for an annual checkup is not suitable. Even in this kind of setting, adult primary care providers detect depression less than half of the time among patients who are clinically depressed3; even among those in whom depression is detected, fewer than half will receive adequate treatment.4 I believe that detection and treatment rates could be higher when parents are screened during a pediatric visit because of the trusted nature of the visit.Dr Reingold is right in that parents of children with special health care needs would be doing their children and their families a service by looking after their own health in addition to that of their children's. Pediatricians can help these parents by detecting, with a couple of screening questions, the depression that is preventing them from being the kind of parent that these children need. Just because pediatric primary care providers already have a lot to do is not a reason to suggest that depression screening of parents cannot occur. Adult primary care providers could argue the same. Two questions from a trusted provider to a thankful parent could save a lot of health care time and dollars in the long run.