Primary Care Doctors Urged to Embrace Depression Screening

Although there does not seem to be any comprehensive data on how many primary care doctors are screening their patients for depression these days, the number is probably higher than a decade ago, Michael Compton, M.D, an assistant professor of psychiatry and preventive medicine at Emory University, told Psychiatric News.

The reasons why he suspects this, he said, is because the public is more aware of depression and its treatments than a decade ago and because primary care doctors are also more aware of how prevalent depression is in their patients than they were a decade ago.

Nonetheless, Compton, along with some members of the American College of Preventive Medicine's (ACPM) Prevention Practice Committee, would like to see still more primary care doctors screen their patients for depression. So toward this end they drew up a position statement for the ACPM on the subject that was published in the October Journal of Family Practice.

A similar, though broader policy statement was announced in June by the American Academy of Pediatrics (Psychiatric News, September 4). It encouraged pediatricians to become competent and proactive in screening and diagnosing children exhibiting depression or a range of other mental illnesses, as well as treating or referring them to mental health providers.

Depression screening is easier than many primary care doctors think, Compton and his group wrote, offering additional perspective that accompanied their position statement. “Screening instruments with acceptable sensitivity and specificity are available. These brief paper-and-pencil instruments can be quickly completed by patients in your waiting room … and do not interfere with clinical practice … . You can also use the same instruments for ongoing monitoring of patients receiving treatment for depression.”

And, they pointed out, if primary care doctors do not find such screening instruments to their liking, they can still ask patients two quick questions in this regard: “Over the past month, have you felt down, depressed, or hopeless?” and “Over the past month, have you felt little interest or pleasure in doing things?” Patients who answer “yes” to these questions “may need more in-depth screening and clinical assessment,” they advised.

Compton and his colleagues also offered primary care doctors guidance on what to do if screening indicates that their patients might be depressed. For example, “Primary care physicians may feel competent to perform the diagnostic interview themselves, or they may refer patients identified by screening to a mental health professional. The interview should determine whether a patient meets the [DSM-IV-TR] diagnostic criteria for a depressive disorder … . Reliance on these well-established criteria is generally recommended as the best way to avoid over- or underdiagnosis, billing problems, and legal problems arising from an inaccurate diagnosis or inappropriate use of medications.”

Finally, Compton and his team offered guidance to primary care physicians who would like to treat those patients whom they have diagnosed with depression: “If you treat patients with depression within your own practice, keep in mind that using standardized treatments with established efficacy in psychiatric patients has been shown to be more effective than ‘usual care.’ If you choose to partner with mental health professionals, you can employ various levels of collaboration … .”

If the statement can accomplish only one thing, Compton stressed, “We would like [it] to further raise awareness among primary care providers that depression is highly prevalent, can be screened for without extensive resources, and should be treated in primary care or specialty mental health when it is detected. All primary care practices should have systems in place for the accurate and timely evaluation and treatment of depressive disorders.”

“Screening Adults for Depression in Primary Care: A Position Statement of the American College of Preventive Medicine” is posted at <www.jfponline.com/pages.asp?aid=8010>.