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Collaborative care approaches effective for depression

Integrating the Patient Health Questionnaire–2 and the Patient Health Questionnaire–9 to screen for depression was effective in primary care settings as a first step of collaborative care, according to a brief report published in Psychiatric Services.

Prior research has showed that primary care providers tend to take individual-level approaches to screening for depression; however, collaborative care model interventions can take advantage of mental health resources and expand the reach of mental health care into primary care, Hale Thompson, PhD, from the department of psychiatry, Rush University Medical Center, and colleagues wrote.

Thompson and colleagues examined depression screening, referrals and treatment uptake in the first 14 months of implementation of a collaborative care intervention across 10 clinics in Chicago.

The intervention uses an algorithm in the electronic health record to determine eligibility for Patient Health Questionnaire–2 (PHQ-2) screening, then prompts the medical assistant to administer the questionnaire to eligible patients aged 12 years and older. Those with scores of 3 or more then receive the Patient Health Questionnaire–9 (PHQ-9) and, if a patient scores 10 or higher on the PHQ-9, the EHR prompts the clinician to refer them to mental health resources. Acting on the referral, a care manager calls the patient to talk about symptoms and treatment options and may offer brief cognitive behavioral therapy or a community referral while they receive treatment, then the clinician will ask the patient to return for a follow-up visit in 6 to 8 weeks.

Researchers assessed any screening and treatment disparities on the basis of gender, race, ethnicity and age.

PCPs screened 25,369 patients between November 2016 and December 2017. Overall, 63% of the sample was female, 44% were white, 36% were black, 19% were Hispanic/Latinx, 20% were aged 12 to 17 years and 19% were aged 26 to 35 years.

Before the launch of the intervention, 7.2% of eligible patients were screened with the PHQ-2; however, the results showed that 79% of patients were screened with the PHQ-2 during the first 14 months of the intervention and 66% (n = 1,042) of eligible patients were screened with the PHQ-9. Of those screened with the PHQ-9, 76% scored a 10 or higher. The researchers found that teenagers were disproportionately screened with the PHQ-9, but they were not engaging in treatment (11%).

In total, 638 patients were referred to collaborative care and 58% of these patients (n = 370) engaged in some form of treatment. Most patients chose medication to treat depression (78%) and only 9% chose brief CBT.

“Population-level screening is one way to integrate mental health into primary care,” Thompson and colleagues wrote. “This strategy normalizes mental health, thus addressing associated stigma; provides an entry into mental health care that many patients may not otherwise have; and when depressed patients opt for antidepressant medication, visits to primary care increase for medication management.” – by Savannah Demko

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