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Depression screening rates low in US

Sandipan Bhattacharjee

Although the national screening rate for depression rose significantly after 2009, screening remains low among adults without a depression diagnosis in the United States, according to data published in Psychiatric Services.

“There are a few studies that have examined the depression screening rate in the general population,” Sandipan Bhattacharjee, MS, PhD, from the department of pharmacy practice and science, College of Pharmacy, University of Arizona, told Healio Psychiatry. “However, the question that intrigued us was what was happening to adults who do not have a depression diagnosis in terms of getting depression screening in a nonpsychiatric setting. A depression screening recommendation was published in 2009 and we wanted to see how that might have influenced depression screening in U.S.”

Using a cross-sectional design and pooled data from the National Ambulatory Medical Care Survey (2005 to 2015), the researchers assessed national patterns, predictors and trends in depression screening among adults without depression diagnosis in the U.S. They conducted descriptive statistics, logistic regression, and piecewise regression analyses.

The investigators selected 2009 as the inflection point because that’s when the initial US Preventive Services Task Force recommendation for depression screening was published. They examined national screening rates from 2005 to 2008 (prerecommendation period), 2010 to 2011 (immediate post-recommendation period) and 2012 to 2015 (late post-recommendation period).

About 105 million visits reported depression screening from 2005 to 2015 in the U.S., representing 1.4% (95% CI, 1.19-1.56) of all adult ambulatory care visits who didn’t have a depression diagnosis. Analysis showed that the rates varied over time, with the lowest in 2008 (0.65%; 95% CI, 0.35-0.95) and the highest in 2015 (3%; 95% CI, 1.93-4.07). In addition, Bhatacharjee and colleagues found that year, gender, physician specialty, geographic region and time spent with doctor were significantly tied to depression screening.

Multivariable logistic regression analyses revealed a higher likelihood of depression screening each year (OR = 1.12; 95% CI, 1.06-1.18; P < .001) and piecewise regression analysis revealed a statistically significant interaction between year and change in depression screening rate. Screening rates rose significantly after 2009. Further analysis showed a smaller likelihood of depression screening during the prerecommendation period (OR = 0.78; 95% CI, 0.65-0.91; P = .002), but higher likelihood during the immediate and late post-recommendation periods (OR = 1.46; P = .016; and OR = 1.34; P < .001).

“Health care providers should routinely use depression screening in their practice so that necessary interventions can be put in place at the right stage to prevent negative outcomes associated with depression as well as overcome the under-diagnosis of depression,” Bhattacharjee told Healio Psychiatry. – by Savannah Demko

Disclosure: Bhattacharjee reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.