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Depression screening rates in primary care low

Only about 4% of adults were screened for depression in primary care 10 years after the U.S. Preventive Services Task Force first recommended such screening, according to research recently published in Psychiatric Services in Advance.

The 2002 USPSTF guidelines stated that screening adults for depression was recommended in clinical practices that have systems in place to assure accurate diagnosis, effective treatment, and follow-up.

Ayse Akincigil

“Primary care settings are an opportune location for early identification of depression, as many depressed patients’ contact with the health care system is through primary care,” Ayse Akincigil, PhD, associate professor, School of Social Work, Rutgers University, New Brunswick, New Jersey, said in a press release discussing the new study. “The findings suggest missed opportunities for depression screening in the general population.”

Akincigil and, Elizabeth B. Matthews, MSW, a doctoral student in the School of Social Work, performed a secondary analysis of data collected from 33,653 patient-physician encounters among adults without existing depression during the 2012 and 2013 National Ambulatory Medical Care Survey. The data collection instrument was a 59-item checklist of medical services provided during the appointment, including depression screening. Further, if a diagnosis of depression was connected to the sampled visit, it was accepted that depression screening occurred, even if it was not marked as such on the checklist, given that patients presenting with depression were already excluded from the study population.

They found that overall, 4.2% of the patients studied were screened for depression, and in 47% of the visits in which screening took place, a new depression diagnosis occurred. This suggests that screening was heavily influenced by whether depression was suspected, according to the researchers. Akincigil and Matthews stated that patients aged 65 or older were less likely to be screened than those who were middle-aged (AOR = 0.48), women were more likely to be screened for depression than men (AOR = 1.36) and that each additional chronic condition a patient had increased the odds of screening (AOR = 1.51). The researchers also found that providers who had completely moved over to an electronic health record (EHR) system were more likely to screen for depression than those who were still using paper charts (AOR = 1.81). Matthews explained the significance of using the electronic systems as it related to her study.

“EHR systems can be an effective tool for improving depression screening through the use of clinical decision support systems. These are a common feature of EHR systems, and provide users with automated prompts when specified tests or screenings are indicated. Using this system, EHRs can be utilized to alert providers when routine depression screening is due or overdue for patients presenting for care,” she told Healio Family Medicine. “There is evidence suggesting that clinical decision support systems have improved rates of depression screening among some specialty populations, though less is known about how they impact depression screening for the general adult primary care population.”

Since the 2002 USPSTF recommendation alluded to in this study, the task force has updated and expanded its recommendations related to depression. Most recently, these recommendations included screening all adults, as well as pregnant and postpartum women, for depression.

Akincigil and Matthews’ researched focus on adults; other recently published research has indicated there is insufficient evidence for accuracy of depression screening tools for major depressive disorder in children and adolescents. In addition to the use of EHRs, other recommendations have included having a simple set of questions to facilitate screening. – by Janel Miller

Disclosure: The researchers report no relevant financial disclosures.

Further reading: 

Ann Intern Med. 2002:doi:10.7326/0003-4819-136-10-200205210-00012.