Universal Depression Screening Research Articles

She Screened Positive for Depression at the First Prenatal Visit, What Really Happens Next?

The aim of this mixed-methods study was to evaluate how providers in a busy urban practice with universal depression screening and co-located behavioral health services responded to positive screens and to explore patient expectations and attitudes towards positive screens. Semi-structured interviews of 20 pregnant women were conducted within 10days of a positive depression screen or endorsement of suicidal ideation on the Edinburgh Perinatal Depression Scale and health record documentation was reviewed. Qualitative data were entered into a meta-matrix and cross-case analysis was used to reduce the data and determine prominent patterns and themes. Most participants reported discussing their mood with their provider, appreciated the discussion and were satisfied with the plan. Most had documentation of a discussion by their provider. Only4 of 9 participants who endorsed thoughts of self-harm had documentation of a discussion regarding their response. While nearly all women were recommended for psychotherapy, most did not receive it. Participants expected follow-up but few had discussion of mood documented at the second prenatal visit, independent of seeing the same provider. Co-located behavioral health did not guarantee that services were utilized. There is a need to incorporate tested integrated care approaches to improve assessments and linkage to effective depression treatment.

Perinatal depression screening practices in a large health system: identifying current state and assessing opportunities to provide more equitable care

The purpose of this study was to assess the prevalence of prenatal and postpartum depression screening in a large health system and to identify covariates for screening, with a specific focus in understanding disparities in practice. A retrospective cohort of women with deliveries in 2016 was created using electronic health records. Primary outcomes were depression screening during pregnancy and the first 3 months postpartum. Generalized linear mixed models with women nested within clinic were used to determine the effect of maternal and clinical characteristics on depression screening. The sample included 7548 women who received prenatal care at 35 clinics and delivered at 10 hospitals. The postpartum sample included 7059 women who returned within 3 months for a postpartum visit. Of those, 65.1% were screened for depression during pregnancy, and 64.4% were screened postpartum. Clinic site was the strongest predictor of screening, accounting for 23–30% of the variability in screening prevalence. There were no disparities identified with regard to prenatal screening. However, several disparities were identified for postpartum screening. After adjusting for clinic, women who were African American, Asian, and otherwise non-white (Native American, multi-racial) were less likely to be screened postpartum than white women (AOR (CI)’s 0.81 (0.65, 1.01), 0.64 (0.53, 0.77), and 0.44 (0.21, 0.96), respectively). Women insured by Medicaid/Medicare, a proxy for low-income, were less likely to be screened postpartum than women who were privately insured (AOR (CI) 0.78 (0.68, 0.89)). National guidelines support universal depression screening of pregnant and postpartum women. The current study found opportunities for improvement in order to achieve universal screening and to deliver equitable care.

PMH21 PROVIDING THE DEPRESSION CARE FOR PEOPLE WITH CANCER PROGRAM TO PROSTATE CANCER PATIENTS IN THE UNITED STATES: A COST-EFFECTIVENESS ANALYSES

Prostate cancer patients in the United States have unmet needs for depression care. These needs could be fulfilled by an integrated care model for managing comorbid depression called the Depression care for People with Cancer program (DCPC). However, little is known about DCPC’s cost-effectiveness in the United States, and this evidence gap may impede DCPC’s adoption. This study used simulation modeling to examine the cost-effectiveness of providing DCPC to prostate cancer patients in the United States. A mathematical model was used to simulate primary and cancer care clinic visits, onset of depression, as well as depression-related care, health outcomes, and costs in a hypothetical cohort of newly diagnosed prostate cancer patients. DCPC was modelled as a sequential combination of universal depression screening, post-screening evaluations, depression treatment with combination therapy, and appropriate follow-up care. Model inputs were obtained from the literature. Primary outcomes were lifetime depression care costs, quality-adjusted life expectancy (measured in quality-adjusted life-years, QALYs), and incremental cost-effectiveness ratios. Secondary Outcomes were measures of survival (i.e. life expectancy, and cumulative incidences of depression-related suicides and prostate cancer deaths), quality of survivorship and care. The model was validated using data from independent empirical studies. DCPC dominated usual care by offering higher QALE at lower cost (from averting depression misdiagnoses and non-indicated care). Other benefits of DCPC were five additional depression-free months, shorter depressive episodes (by two months), and a 43% reduction in the chance of ever initiating maintenance therapy for depression. DCPC’s tradeoffs included a higher cumulative incidence of depression (from 55% to 64%) and an additional lifetime depressive episode on average. Measures of survival were identical under usual care and DCPC. Results of sensitivity analyses indicate that DCPC was almost always preferable to usual care. DCPC will offer good value for money when provided to US prostate cancer patients.

Implementing collaborative care to reduce depression for rural native American/Alaska native people

BackgroundThe purpose of this study was to identify the effects of Collaborative Care on rural Native American and Alaska Native (AI/AN) patients.MethodsCollaborative Care was implemented in three AI/AN serving clinics. Clinic staff participated in training and coaching designed to facilitate practice change. We followed clinics for 2 years to observe improvements in depression treatment and to examine treatment outcomes for enrolled patients. Collaborative Care elements included universal screening for depression, evidence-based treatment to target, use of behavioral health care managers to deliver the intervention, use of psychiatric consultants to provide caseload consultation, and quality improvement tracking to improve and maintain outcomes. We used t-tests to evaluate the main effects of Collaborative Care and used multiple linear regression to better understand the predictors of success. We also collected qualitative data from members of the Collaborative Care clinical team about their experience.ResultsThe clinics participated in training and practice coaching to implement Collaborative Care for depressed patients. Depression response (50% or greater reduction in depression symptoms as measured by the PHQ-9) and remission (PHQ-9 score less than 5) rates were equivalent in AI/AN patients as compared with White patients in the same clinics. Significant predictors of positive treatment outcome include only one depression treatment episodes during the study and more follow-up visits per patient. Clinicians were overall positive about their experience and the effect on patient care in their clinic.ConclusionsThis project showed that it is possible to deliver Collaborative Care to AI/AN patients via primary care settings in rural areas.

1121: Correlation of universal screening for maternal depression with birth weight and preterm birth

Perinatal mood and anxiety disorders (PMADs) are the most common perinatal complications. As awareness of PMADs grows, questions have arisen regarding the therapeutic value of screening alone. This study investigated whether universal screening for maternal depression and the Edinburgh Postnatal Depression Survey (EPDS) scores correlated with birth weight between a pre-implementation control cohort and a post-implementation study cohort. This study also investigated whether preterm birth rates varied between the two cohorts. The two cohorts received prenatal care from the same obstetric practices and delivered at the same large, urban hospital. Beginning in 9/2019 an EPDS was universally administered three times to the study cohort. This occurred at the first prenatal visit, once during the third trimester, and at the hospital postpartum. Gestational age at delivery (GA), birth weight and EDPS scores were compared to a control cohort who did not receive universal screening as pregnancies were prior to 9/2019. T-tests were used to assess continuous data and Pearson correlations were used to assess screening data and pregnancy outcomes. 3884 pregnancies prior to implementation of universal screening were compared with 3885 pregnancies after implementation. GA and birth weight were similar between the two groups. Preterm birth rate was 12% in control cohort versus 12.35 % in the study cohort. Negative correlations were seen between EPDS scores postpartum and GA at delivery (r= -0.12, p < 0.0001) as well as between EDPS scores and birth weight (r= -0.08, p < 0.0001). EPDS was significantly correlated to age and parity. Higher EPDS score postpartum is associated with earlier GA at delivery and lower birth weight. As universal screening for PMADs expands, we should regard PMADs with the same attention as other “high-risk” pregnancy complications to improve perinatal outcomes such as preterm birth and birth weight.

Effects of psychological treatment of mental health problems in pregnant women to protect their offspring: randomised controlled trial.

Perinatal depression and anxiety are associated with unfavourable child outcomes. To assess among women with antenatal depression or anxiety the effectiveness of prenatally initiated cognitive-behavioural therapy (CBT) on mother and child compared with care as usual (CAU). Trial registration: Netherlands Trial Register number NTR2242. Pregnant women (n = 282) who screened positive for symptoms of depression and/or anxiety were randomised to either CBT (n = 140) or CAU (n = 142). The primary outcome was child behavioural and emotional problems at age 18 months, assessed using the Child Behavior Checklist (CBCL). Secondary outcomes were maternal symptoms during and up to 18 months after pregnancy, neonatal outcomes, mother-infant bonding and child cognitive and motor development at age 18 months. In total, 94 (67%) women in the CBT group and 98 (69%) in the CAU group completed the study. The mean CBCL Total Problems score was non-significantly higher in the CBT group than in the CAU group (mean difference: 1.38 (95% CI -1.82 to 4.57); t = 0.85, P = 0.399). No effects on secondary outcomes were observed except for depression and anxiety, which were higher in the CBT group than in the CAU group at mid-pregnancy. A post hoc analysis of the 98 women with anxiety disorders showed lower infant gestational age at delivery in the CBT than in the CAU group. Prenatally initiated CBT did not improve maternal symptoms or child outcomes among non-help-seeking women with antenatal depression or anxiety. Our findings are not in line with present recommendations for universal screening and treatment for antenatal depression or anxiety, and future work may include the relevance of baseline help-seeking.

Effect of Depression Screening After Acute Coronary Syndromes on Quality of Life

Patients with acute coronary syndrome (ACS) and elevated depressive symptoms are at increased risk for recurrent cardiovascular events and mortality, worse quality of life, and higher health care costs. These observational findings prompted multiple scientific panels to advise universal depression screening in survivors of ACS prior to evidence from randomized screening trials. To determine whether systematically screening for depression in survivors of ACS improves quality of life and depression compared with usual care. A 3-group multisite randomized trial enrolled 1500 patients with ACS from 4 health care systems between November 1, 2013, and March 31, 2017, with follow-up ending July 31, 2018. Patients were eligible if they had been hospitalized for ACS in the previous 2 to 12 months and had no prior history of depression. All analyses were performed on an intention-to-treat basis. Patients with ACS were randomly assigned 1:1:1 to receive (1) systematic depression screening using the 8-item Patient Health Questionnaire, with notification of primary care clinicians and provision of centralized, patient-preference, stepped depression care for those with positive screening results (8-item Patient Health Questionnaire score ≥10; screen, notify, and treat, n = 499); (2) systematic depression screening, with notification of primary care clinicians for those with positive screening results (screen and notify, n = 501); and (3) usual care (no screening, n = 500). The primary outcome was change in quality-adjusted life-years. The secondary outcome was depression-free days. Adverse effects and mortality were assessed by patient interview and hospital records. A total of 1500 patients (424 women and 1076 men; mean [SD] age, 65.9 [11.5] years) were randomized in the 18-month trial. Only 71 of 1000 eligible survivors of ACS (7.1%) had elevated 8-item Patient Health Questionnaire scores indicating depressive symptoms at screening. There were no differences in mean (SD) change in quality-adjusted life-years (screen, notify and treat, -0.06 [0.20]; screen and notify, -0.06 [0.20]; no screen, -0.06 [0.18]; P = .98) or cumulative mean (SD) depression-free days (screen, notify and treat, 343.1 [179.0] days; screen and notify, 351.3 [175.0] days; no screen, 339.0 [176.6] days; P = .63). Harms including death, bleeding, or sleep difficulties did not differ among groups. In patients with ACS without a history of depression, systematic depression screening with or without providing depression treatment did not alter quality-adjusted life-years, depression-free days, or harms. ClinicalTrials.gov identifier: NCT01993017.

Depression screening in youth: Multi-informant algorithms for the child welfare setting.

The Achenbach System of Empirically Based Assessment (ASEBA) represents the most widely used protocol for mental and behavioral health screening in the Child Welfare System (CWS). However, because past studies have (a) relied on the self- or parent report, (b) focused on the internalizing subscales, (c) focused solely on current or prospective depression, and (d) not assessed incremental validity, it is difficult to use the ASEBA to address recommended universal depression screening initiatives in the CWS. In response, the present study used an evidence-based medicine (EBM) framework to identify the best combination of subscales that predict adolescent depression outcomes within the CWS. Overall, we found that a combination of self-reported internalizing symptoms, and to a lesser extent, self-reported attention problems, delinquent behavior, and parent-reported social problems best forecasted concurrent depression status. Meanwhile, self-reported anxious/depressed and externalizing symptoms, in addition to parent-reported somatic complaints and withdrawn symptoms, were necessary to adequately forecast prospective depression outcomes. Using these algorithms, we were able to differentiate and classify youth at minimal, moderate, or substantial risk for current and future depression symptoms. Findings are contextualized with past research on the Achenbach scales and clinical implications for more targeted depression screening are discussed. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Outcomes of Implementing Routine Screening and Referrals for Perinatal Mood Disorders in an Integrated Multi-site Pediatric and Obstetric Setting

We report on a successful quality improvement project designed to increase access to perinatal mental health services through universal screening for postpartum depression (PPD) and facilitating referrals for evaluation and treatment, at a multi-site, integrated system of pediatric and obstetric practices in Houston, Texas. Obstetric practices administered screenings twice during pregnancy and at 6weeks postpartum. Pediatric practices screened women at the 2week and 2, 4, and 6-month well-baby visit. Women with a score of 10 or higher on the Edinburgh Postnatal Depression Scale (EPDS) or women that reported thoughts of self-harm were offered a referral to a mental health provider. Data on screening and referrals were collected from the electronic medical record. A total of 102,906 screens for PPD were completed between May 2014 and July 2018. Of those, 6487 (6.3%) screened positive. The total number of women referred to treatment were 3893 (3.8%). Of referred women 2172 (55.8%) completed an appointment with a mental health provider within 60days of referral. Rates of completed appointments varied by the level of integration of the mental health provider and referring physician: women referred by pediatrics in a Level 1 coordinated system completed 20.0% of referrals; obstetrics Level 4 co-located system, 76.6%; and obstetrics Level 5 integrated model, 82.7%. This project demonstrated that with planning, systems review and trained staff, PPD screening can be integrated into obstetric and pediatric practices and high screening and referral rates can be achieved.

Prevalence and characteristics of universal depression screening in U.S. college health centers.

Whereas universal depression screening has potential to increase identification of mental health concerns among college students, the prevalence of universal screening in college health centers is unknown. This study provides an estimate of the prevalence of universal depression screening at public, 4-year universities in the United States. It also documents systems-level facilitators and correlates of universal screening, as well as reasons for not screening. Online cross-sectional survey of college health center directors and student health personnel of public 4-year universities. There were 131 participants who responded to the survey (25% response): 64.2% (54-74%; 95% confidence interval [CI]) of respondents reported that their clinics use universal depression screening. Characteristics associated with universal depression screening use clustered around systems-level resources, including larger student populations and health care staff, greater perceived financial resources, and shorter estimates of time required for screening. Universal screening use was also associated with respondents' awareness of the U.S. Preventive Services Task Force (USPSTF) recommendation, agreement with the evidence base supporting universal depression screening, and beliefs that codified standards support effective care. Leading reasons for not screening included: lack of mental health professionals, provider reluctance, liability concerns, and lack of clinic space. Universal depression screening is reasonably common among college health centers. Care planner discussions regarding depression screening initiatives should address resource concerns, awareness of the USPSTF recommendation and evidence base, and information about the average time it takes to screen. Future research should examine functional outcomes and implementation experiences of college health centers that have adopted universal depression screening. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

VitalSign6: A Primary Care First (PCP-First) Model for Universal Screening and Measurement-Based Care for Depression.

Major depressive disorder affects one in five adults in the United States. While practice guidelines recommend universal screening for depression in primary care settings, clinical outcomes suffer in the absence of optimal models to manage those who screen positive for depression. The current practice of employing additional mental health professionals perpetuates the assumption that primary care providers (PCP) cannot effectively manage depression, which is not feasible, due to the added costs and shortage of mental health professionals. We have extended our previous work, which demonstrated similar treatment outcomes for depression in primary care and psychiatric settings, using measurement-based care (MBC) by developing a model, called Primary Care First (PCP-First), that empowers PCPs to effectively manage depression in their patients. This model incorporates health information technology tools, through an electronic health records (EHR) integrated web-application and facilitates the following five components: (1) Screening (2) diagnosis (3) treatment selection (4) treatment implementation and (5) treatment revision. We have implemented this model as part of a quality improvement project, called VitalSign6, and will measure its success using the Reach, Efficacy, Adoption, Implementation, and Maintenance (RE-AIM) framework. In this report, we provide the background and rationale of the PCP-First model and the operationalization of VitalSign6 project.

Universal Depression Screen of Ambulatory Cardiac Transplant Recipients is Feasible and Identifies a Subset of Patients That May Benefit from Mental Health Intervention

Purpose Patients with a heart transplant who have depression have higher rates of graft failure and noncompliance; however, patients identified and treated early have outcomes similar to those without depression. The aim of this quality improvement project was to assess feasibility of implementing a universal depression screen—via the Patient Health Questionnaire (PHQ)-in a busy ambulatory heart transplant clinic. Methods Heart transplant team members were educated via an online module about depression screening. The PHQ was embedded in the electronic health record. Depression screening (PHQ2) was performed by an RN during the check-in process. For those patients who screened positive for depression (PHQ2 ≥3), the PHQ9 was administered. Patients who scored positive for moderate or severe depression (PHQ9 ≥10) received a follow-up phone call and referral to mental health services. Primary outcomes were the percentage of patients who underwent successful depression screening and received follow-up. Secondary outcomes included average time for completion of depression screening and level of burden for team members (5-point Likert scale, 5=significant burden, 1=no burden at all). Results From July-September 2018, there were 388 clinic visits; PHQ2 screens were completed during 363 (94%) of those visits. There were 223 unique patients seen during this time, of which 214 underwent a depression screening assessment. Initial PHQ2 identified 21 patients (6%) who screened positive for depression, of which all 21 had PHQ9 assessment. The PHQ9 identified 17 patients (4%) as having moderate or severe depression. All 17 patients were provided with mental health resources and received follow-up phone calls. Median time to administer PHQ2 was 2 minutes (range 1-2). Median time to administer PHQ9 was 5 minutes (range 5-15). Mean transplant provider burden score for depression screening was 1.6 (range 1-2). Conclusion Implementation of routine universal depression screening in an outpatient heart transplant clinic is feasible, identifies patients with depression, and does not result in clinical burden. Further investigation is needed to determine whether this universal depression screening and resultant early referral to mental health services positively effects long-term graft and patient survival.

The relationship between neonatal encephalopathy and maternal postpartum depression

Purpose: Neonatal hypoxic–ischemic encephalopathy (HIE) is a type of brain injury resulting from insufficient oxygen and blood supply. The standard treatment for HIE is therapeutic hypothermia (TH), which involves a 72-h period of hypothermia, during which time the infant is isolated from his/her parents. The primary objective of this study was to assess the effects of the diagnosis of neonatal encephalopathy and subsequent separation on rates of maternal postpartum depression (PPD) as compared to other hospitalized infants.Materials and methods: Case-control analysis of newborns admitted to the neonatal intensive care unit from 2015 to 2018 was carried out. Maternal PPD symptoms were determined by the Edinburgh Postnatal Depression Scale (EPDS). Demographics, diagnoses, and outcomes were abstracted from clinical records. Associations between EPDS scores and HIE diagnosis and severity, insurance type, marital status, markers of overall illness severity, and the need for neonatal transport were evaluated. Student’s t-test and Fisher’s exact test were used to compare differences in continuous and categorical variables, respectively. A multiple regression model was used to adjust for markers of illness severity.Results: The study found no association between EPDS scores and marital status, overall illness severity, or the need for transport. A trend toward higher EPDS scores was noted in mothers of infants with HIE versus other admission diagnoses (21 versus 10%, p = .09). A similar trend was seen in mothers of infants with severe versus moderate encephalopathy (30 versus 7%, p = .12). Mothers of infants with no insurance (20%) or Medicaid (16%) had higher rates of PPD than those with private (6%) or military insurance (6%) (p = .02).Conclusions: Mothers of infants with HIE are at high risk for PPD, which may be in part related to TH interfering with maternal–infant bonding. These findings support the need for continued universal depression screening with investigation of new methods to reduce stress and improve the bonding experience during and after TH.

Incorporating Recognition and Management of Perinatal Depression Into Pediatric Practice.

Perinatal depression is the most common obstetric complication in the United States, with prevalence rates of 15% to 20% among new mothers. Untreated, it can adversly affect the well-being of children and families throught increasing the risk for costly complications during birth and lead to deterioration of core supports, including partner relationships and social networks. Perinatal depression contributes to long-lasting, and even permanent, consequences for the physical and mental health of parents and children, including poor family functioning, increased risk of child abuse and neglect, delayed infant development, perinatal obstetric complications, challenges with breastfeeding, and costly increases in health care use. Perinatal depression can interfere with early parent-infant interaction and attachment, leading to potentially long-term disturbances in the child's physical, emotional, cognitive, and social development. Fortunately, perinatal depression is identifiable and treatable. The US Preventive Services Task Force, Centers for Medicare and Medicaid Services, and many professional organizations recommend routine universal screening for perinatal depression in women to facilitate early evidence-based treatment and referrals, if necessary. Despite significant gains in screening rates from 2004 to 2013, a minority of pediatricians routinely screen for postpartum depression, and many mothers are still not identified or treated. Pediatric primary care clinicians, with a core mission of promoting child and family health, are in an ideal position to implement routine postpartum depression screens at several well-child visits throughout infancy and to provide mental health support through referrals and/or the interdisciplinary services of a pediatric patient-centered medical home model.

Adolescent Depression: Identification and Treatment

Adolescent depression is a prevalent condition that has been on the rise in recent years. The primary care setting is often the front line to mental health needs, specifically identifying and treating early depression. This review presents the current evidence base about adolescent depression, its identification, and treatment approaches. The US Preventive Services Task Force and American Academy of Pediatrics recommend universal screening for depression in adolescents in primary care settings. There are several depression screening measures that could be useful in primary care. Recommended treatment approaches which include therapy, medication, or a combination of the two are based on an adolescent’s presentation and degree of impairment. There is sufficient empirical evidence supporting use of three therapies and two Selective Serotonin Reuptake Inhibitors for adolescent depression. Currently, there are resources, screening measures, and research evidence available to adequately support pediatricians in the identification and treatment of adolescent depression.

Differences in Screening and Treatment for Antepartum Versus Postpartum Patients: Are Providers Implementing the Guidelines of Care for Perinatal Depression?

National guidelines recommend universal depression screening for perinatal patients and provide treatment recommendations to prevent adverse maternal/child health outcomes. However, providers rarely screen all patients, and most women with perinatal depression remain undertreated. This study investigated predictors of universal screening and guideline-congruent care for perinatal depression by obstetrician-gynecologists and examined differences in practices with pregnant and postpartum patients. A random, national sample of obstetric providers (n = 483) from a three-wave mailing completed the survey. Regression analysis showed that providers universally screened (53.04% vs. 82.40%; p < 0.001) and implemented guideline-congruent care (33.61% vs. 58.51%; p < 0.001) with pregnant patients at a lower rate than with postpartum patients. Predictors of antenatal universal screening included the following: external influences, including screening as a clinic priority (adjusted odds ratio [AOR] 1.85; 95% confidence intervals [CIs]: 1.42-2.40), and intrinsic factors related to familiarity with mental health providers. Predictors of universal postpartum screenings included the following: clinic priority (AOR 3.01; 95% CIs: 2.12-4.28), provider comfort with diagnosing depression (AOR 1.58; 95% CIs: 1.04-2.39), and provider belief of patients unlikely to disclose depression unprompted (AOR 0.40; 95% CIs: 0.24-0.68). The only predictor of guideline-congruent care with pregnant patients was provider motivation (AOR 1.32; 95% CIs: 1.09-1.61). Predictors of postpartum guideline-congruent care included the following: comfort with prescribing antidepressants (AOR 1.98; 95% CIs: 1.53-2.57) and provider belief that depression will not resolve on its own (AOR 1.33; 95% CIs: 1.07-1.65). This study displays differences in perinatal depression care for pregnant and postpartum patients, particularly disparities for pregnant patients. The findings highlight facilitating factors for translating guidelines into routine practices.

Correlation of sociodemographic and clinical parameters with depression and distress in patients with hematologic malignancies.

A quarter of cancer patients struggle with distress or depression during their illness. Multiple organizations including the National Comprehensive Cancer Network recommend universal screening for distress and depression. Herein, we describe a universal screening program in patients with hematologic malignancies and factors associated with distress and depression. Between December 2013 and February 2015, patients with hematologic malignancies took the Patient Health Questionnaire 9 (PHQ-9) and Distress Thermometer (DT) prior to receiving their first outpatient parenteral chemotherapy. Patient demographic information as well as information regarding visit burden and baseline use of psychiatric medications were recorded. A PHQ-9 score of ≥ 9 and a DT score ≥ 4 suggested a high risk of major depression and distress. Intergroup comparisons of categorical and continuous variables were performed via chi-square and Wilcoxon rank-sum tests. Multivariate models were constructed using the stepwise selection technique using all potential variables. Two hundred forty-six patients with a median age at diagnosis 65years (range 18-94 years) were included. In the multivariate analysis, a PHQ-9 score ≥ 9 was associated with living alone (P = 0.007), positive PHQ-2 (P = 0.003), and high Charlson comorbidity index (CCI; P = 0.02), while a DT score ≥ 4 was associated with being married (P = 0.03) and female (P = 0.03). There was no other association with high scores on either questionnaire. Patients with hematologic malignancies often have prolonged treatment and surveillance. We identified subpopulations within this group who may be at high risk of developing distress and depression and who should be aggressively screened even when universal screening programs are not available.

Delivering perinatal depression care in a rural obstetric setting: a mixed methods study of feasibility, acceptability and effectiveness

Objectives: Universal screening for depression during pregnancy and postpartum is recommended, yet mental health treatment and follow-up rates among screen-positive women in rural settings are low. We studied the feasibility, acceptability and effectiveness of perinatal depression treatment integrated into a rural obstetric setting. Methods: We conducted an open treatment study of a screening and intervention program modified from the Depression Attention for Women Now (DAWN) Collaborative Care model in a rural obstetric clinic. Depression screen-positive pregnant and postpartum women received problem-solving therapy (PST) with or without antidepressants. A care manager coordinated communication between patient, obstetrician and psychiatric consultant. We measured change in the Patient Health Questionnaire 9 (PHQ-9) score. We used surveys and focus groups to measure patient and provider satisfaction and analyzed focus groups using qualitative analysis. Results: The intervention was well accepted by providers and patients, based on survey and focus group data. Feasibility was also evidenced by recruitment (87.1%) and retention (92.6%) rates and depression outcomes (64% with >50% improvement in PHQ 9) which were comparable to clinical trials in similar urban populations. Conclusions for practice: DAWN Collaborative Care modified for treatment of perinatal depression in a rural obstetric setting is feasible and acceptable. Behavioral health services integrated into rural obstetric settings could improve care for perinatal depression.

Does Depression Screening in Schools Reduce Adolescent Racial/Ethnic Disparities in Accessing Treatment?

Although placing mental health services in schools increases access to care, racial/ethnic disparities persist within the scope of school-based mental health services. Universal mental health screening is a potential strategy to increase problem detection and reduce disparities in care provision. However, no study has experimentally tested the effect of universal screening on patterns of service utilization across racial groups and the potential to reduce disparities. Using a cluster randomized design, we compared service linkage patterns among 7th- and 8th-grade Asian American and Latino students (N = 2,494; Mage = 13.65) in schools that either conducted or did not conduct universal depression screening. Multilevel analyses showed that enrollment in a universal screening school, Latino ethnicity, and low academic performance were associated with greater likelihood of referral. However, these factors were not related to caregiver consent or treatment initiation. Screening-triggered referrals were less likely to result in caregiver consent compared to routine referrals. Furthermore, universal screening did not result in a statistically significant reduction in racial/ethnic disparities in treatment referral. Implications for engaging ethnic minority families beyond the point of problem recognition and referral are discussed.

Universal Depression Screening to Improve Depression Outcomes in Primary Care: Sounds Good, but Where Is the Evidence?

The 2016 recommendation statement by the U.S. Preventive Services Task Force (USPSTF) endorsed screening for depression in the general adult population. The recommendation was mainly based on studies that compared enhanced depression care that included depression screening with usual care. In contrast to the USPSTF recommendation, the 2013 guidelines from the Canadian Task Force on Preventive Health Care (CTFPHC) recommended against routine depression screening. The CTFPHC could not identify any studies comparing depression outcomes of usual care with and without the addition of routine depression screening. In the absence of evidence of clinical benefit, there are concerns that wide adoption of the USPSTF recommendation for universal depression screening would lead to overdiagnosis of depression and an increase in inappropriate prescription of antidepressant medications.