Screening For Depression In Primary Care Research Articles

Relationship of Depression Screening and Physician Office Visit Duration in a National Sample

Relationship of Depression Screening and Physician Office Visit Duration in a National Sample

Efficacy of Antidepressants and USPSTF Guidelines for Depression Screening

Letters1 June 2010Efficacy of Antidepressants and USPSTF Guidelines for Depression ScreeningEvelyn P. Whitlock, MD, MPH, Elizabeth A. O'Connor, PhD, and Bradley N. Gaynes, MD, MPHEvelyn P. Whitlock, MD, MPHFrom Oregon Evidence-based Practice Center, Kaiser Permanente Center for Health Research, Portland, OR 97227, and University of North Carolina School of Medicine, Chapel Hill, NC 27599.Search for more papers by this author, Elizabeth A. O'Connor, PhDFrom Oregon Evidence-based Practice Center, Kaiser Permanente Center for Health Research, Portland, OR 97227, and University of North Carolina School of Medicine, Chapel Hill, NC 27599.Search for more papers by this author, and Bradley N. Gaynes, MD, MPHFrom Oregon Evidence-based Practice Center, Kaiser Permanente Center for Health Research, Portland, OR 97227, and University of North Carolina School of Medicine, Chapel Hill, NC 27599.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-152-11-201006010-00017 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail IN RESPONSE:We agree that trade-offs may be involved in conducting targeted systematic reviews to efficiently update an evidence-based recommendation. We refer the reader to the USPSTF's procedure manual (1) for further clarification on their rationale and approach for conducting updates.Dr. Poses suggests that explicit inclusion of unpublished trials in meta-analysis would reduce current estimates of antidepressant efficacy, thus undermining the rationale for depression screening in primary care. We do not believe an overestimate has been clearly established, and if it was, there are several reasons why it would not undermine the importance of screening. First and foremost, the ...

Primary care depression screening among American indian and Alaska native adults: The role of patient and provider characteristics

Primary care depression screening among American indian and Alaska native adults: The role of patient and provider characteristics

Screening for Depression in Adult Patients in Primary Care Settings: A Systematic Evidence Review

In primary care settings, prevalence estimates of major depressive disorder range from 5% to 13% in all adults, with lower estimates in those older than 55 years (6% to 9%). In 2002, the U.S. Preventive Services Task Force (USPSTF) recommended screening adults for depression in clinical practices that have systems to ensure accurate diagnosis, effective treatment, and follow-up. To conduct a targeted, updated systematic review for the U.S. Preventive Services Task Force about the benefits and harms of screening adult patients for depression in a primary care setting, the benefits of depression treatment in older adults, and the harms of depression treatment with antidepressant medications. MEDLINE, the Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, Database of Abstracts of Reviews of Effects, PsycINFO (1998 to 2007), expert suggestions, and bibliographies of recent systematic reviews. Fair- to good-quality randomized clinical trials or controlled clinical trials; systematic reviews; meta-analyses; and large observational studies of serious adverse events and early discontinuation due to adverse effects. All studies were published in English. Two investigators abstracted, critically appraised, and synthesized 33 articles that met inclusion criteria. Nine fair- or good-quality trials indicate that primary care depression screening and care management programs with staff assistance, such as case management or mental health specialist involvement, can increase depression response and remission. Benefit was not evident in screening programs without staff assistance in depression care. Seven regulatory reviews or meta-analyses and 3 large cohort studies indicate no increased risk for completed suicide deaths with antidepressant treatment. Risk for suicidal behaviors was increased in young adults (aged 18 to 29 years) who received antidepressants, particularly those who received paroxetine, but was reduced in older adults. Examination of harms was limited to serious adverse events, and existing systematic reviews were primarily used. Additional studies published from 2007 to 2008 extend this review. Depression screening programs without substantial staff-assisted depression care supports are unlikely to improve depression outcomes. Close monitoring of all adult patients who initiate antidepressant treatment, particularly those younger than 30 years, is important both for safety and to ensure optimal treatment.

Recognition and Treatment of Depression and Anxiety Symptoms in Heart Failure

The aim of this prospective study was to examine the prevalence, recognition, and treatment of depression and anxiety in ambulatory patients with heart failure. A total of 158 heart failure participants were enrolled between November 2006 and April 2007. Each patient completed a telephone screening interview that included an assessment of heart-failure severity (New York Heart Assciation criteria) as well as measures for depression (Geriatric Depression Scale [GDS]) and anxiety (Geriatric Anxiety Inventory [GAI]). Following study recruitment, each patient's electronic medical record was comprehensively reviewed for the 12 months prestudy and 6 months poststudy assessments to determine whether patients had been recognized as having and/or treated for depression or anxiety. Prevalence of depression (GDS score ≥ 6) was 41.8%, and prevalence of anxiety (GAI score ≥ 9) was 25.3%. Of patients with a positive GDS or GAI result, 57.5% had a diagnosis or medical-record notation for depression and/or anxiety, and 60.3% received mental health treatment during the 18-month period of the EMR review. Of patients with a documented diagnosis of depression or anxiety, 92.3% received mental health treatment. Results showed that higher GDS scores were associated with recognition of depression/anxiety in the medical record, and a positive primary care depression screening predicted documented mental health treatment. These data suggest that symptomatic depression and anxiety are underrecognized in heart failure patients and that mental health screening may be important for receipt of care. Notably, once depression and/or anxiety was documented in the medical record, patients were highly likely to receive mental health treatment.

Table of Contents

AbstractInfant Mental Health: Babies on the Couch?Journeying into Adolescence with Asperger's SyndromeAdolescents with ADHD Misusing MedsAACAP Calls for Attention to Co‐Occuring DisordersScreening for ASDs at 24‐Months?MDD in Adults Abused as ChildrenSomatic Symptoms in Children with Anxiety DisordersRoutine Depression Screening in Primary Care: Feasibility and AcceptabilityWelcoming Bradley Hospital to the Team

Adolescent Depression Screening in Primary Care: Feasibility and Acceptability

Despite available depression treatments, only one fourth to one third of depressed adolescents are receiving care. The problem of underdiagnosis and underreferral might be redressed if assessment of suicidality and depression became a more formal part of routine pediatric care. Our purpose for this study was to explore the feasibility and acceptability of implementing adolescent depression screening into clinical practice. In this study we implemented a 2-stage adolescent identification protocol, a first-stage pen-and-paper screen and a second-stage computerized assessment, into a busy primary care pediatric practice. Providers tracked the number of eligible patients screened at both health maintenance and urgent care visits and provided survey responses regarding the burden that screening placed on the practice and the effect on patient/parent-provider relationships. Seventy-nine percent of adolescent patients presenting for health maintenance visits were screened, as were the majority of patients presenting for any type of visit. The average completion time for the paper screen was 4.6 minutes. Providers perceived parents and patients as expressing more satisfaction than dissatisfaction with the screening procedures and that the increased time burden could be handled. All providers wished to continue using the paper screen at the conclusion of the protocol. Instituting universal systematic depression screening in a practice with a standardized screening instrument met with little resistance by patients and parents and was well perceived and accepted by providers.

Using the PHQ-9 for Depression Screening and Treatment Monitoring for Chinese Americans in Primary Care

Using the PHQ-9 for Depression Screening and Treatment Monitoring for Chinese Americans in Primary Care

Depression Case Finding in Primary Care: A Method for the Mandates

The current mandates for depression screening in primary care create a dilemma for clinicians. How should screening be implemented in the face of limited evidence for sustainable strategies for effective depression monitoring and management in primary care. In this article we review the issues surrounding primary care depression screening, and develop the argument for a case-finding strategy that includes careful choice of a single instrument, focused identification of high-risk patients, and systematic monitoring of outcomes. We believe this is a sustainable method that primary care clinicians can implement to address the spirit of current depression screening mandates.

Use of brief depression screening tools in primary care: consideration of heterogeneity in performance in different patient groups

Heterogeneity of performance of screening tools in different patient groups has rarely been considered in the literature on depression screening in primary care. The objectives of the present study were to assess and to compare diagnostic accuracy of three screening questionnaires (Brief Patient Health Questionnaire, General Health Questionnaire-12, WHO-5) in identifying depression across various patient subpopulations and to assess the accuracy of the unaided clinical assessment of primary care physicians in the same subgroups. We conducted a cross-sectional validation study in 448 primary care patients. Two-by-two tables as well as receiver operating characteristics were applied. Results indicated that diagnostic accuracy (sensitivity, specificity) of the three screening instruments as well as of the clinical diagnoses differed in the various patient groups. Superiority of one screening tool over the other depends on the subgroup considered. Gender, age, form (subtype), and severity of depression influence the test characteristics of a screening tool. This should be considered if routine depression screening should be widely introduced. Of course, the benefit of routine screening also depends on efforts made for treatment and monitoring of patients in whom depression was diagnosed.

Electronic Medical Records and Depression Screening in Primary Care.

Sir: The article by Gill and Dansky1 in a recent issue of the Companion is an excellent empirical demonstration of the efficiencies that can be gained by employing the electronic medical record as a communication tool in screening for depression. The authors candidly discuss the reasons why similar screening programs in primary care have not always been successful as well as the limitations of screening instruments, such as the Center for Epidemiological Studies Depression Scale,2 which they employed in their study. However, their results suggest that such screening can be accomplished with minimal disruption and that the patients' physicians frequently use these results to conduct further evaluation and, where appropriate, initiate or alter treatment. The authors rightly point out the lack of a comparison “ordinary care group” from which to draw firm conclusions about how much the screening actually improved recognition and treatment. However, it seems likely that an underrecognized, significant disorder was identified and treated more promptly and effectively. Considering that patients with depression often overutilize health care, such a program could be expected to reduce health expenditures as well. As the electronic medical record improves, it may be possible for a patient to complete such a screening questionnaire electronically and for the results to be integrated into the record and posted automatically at the time of the physician interview, thus saving additional staff time. What is clear is that we must invent more effective and efficient ways of delivering health care, and the electronic record holds great promise in accomplishing this.

Use of an Electronic Medical Record to Facilitate Screening for Depression in Primary Care.

BACKGROUND: Screening programs for depression often fail to improve care because of lack of adequate communication and follow-up. The purpose of this study was to examine a primary care depression screening program that utilized an electronic medical record (EMR) to improve communication and follow-up. METHOD: All adult patients in a family practice office were screened for depression using the Center for Epidemiological Studies Depression Scale (CES-D) during the period March 2000 through March 2001. Screening results were communicated to the primary physician via the EMR, and the physician communicated his or her plan back to the nurse via the EMR. In this retrospective cohort study, we included all persons who screened positive on the CES-D and examined their rate of new psychiatric diagnoses, new psychotropic medications, and change in CES-D scores 3 months after the initial screening. RESULTS: Of 1092 patients who completed the CES-D, 247 (22.6%) screened positive for depression. Among these, 35% had a new psychiatric diagnosis, 31% were prescribed new psychotropic medications, and 46% had a change in psychotropic medications. The vast majority of these were depression diagnoses and antidepressant medications. For the 94 persons who completed the CES-D at 3-month follow-up, there was a mean decrease in CES-D scores of 2.87 (p <.05). CONCLUSION: This study demonstrates a positive impact of a depression screening program that utilized an EMR to facilitate communication and follow-up. Such programs could help to improve detection and treatment of depression in other primary care settings.