Integrated Care Goes Global In Depression Screening Project

With depression cited by the World Health Organization as one of the leading causes of disability worldwide, a pilot project sponsored by the World Psychiatric Association (WPA) Task Force on Noncommunicable Diseases is gathering data that could eventually help relieve the burden caused by depression, especially in low-income and low-middle-income countries.

The Depression Screening in Primary Care project is a global epidemiology initiative whose focus is assessing depression prevalence in primary care settings and its comorbidity with common noncommunicable diseases such as diabetes and cardiovascular diseases, especially hypertension. Another goal of the project is to stimulate new research and services innovations based on collaborative care concepts that are tailored to the needs and available resources of individual countries.

So far the pilot project has been active in India, Iran, Romania, Pakistan, and China, said Eliot Sorel, M.D., who helped found the project as cochair of the WPA task force and continues to serve as a consultant to the project. Sorel is a clinical professor of psychiatry and behavioral sciences in the School of Medicine and Health Sciences and of global health, health systems management, and leadership in the School of Public Health at George Washington University.

“People worldwide remain unaware of the comorbidity of depression and other medical illness,” Sorel emphasized, thus there is a serious need to establish collaborative programs that comprehensively address the issues that arise in the diagnosis and treatment of comorbid mental and general health disorders.

Sorel explained that in each country in which the project has worked, it arranges collaborations with leading psychiatrists, primary care physicians, and public-health professionals in academic institutions, clinical services, and the country’s professional psychiatric organization—“people with knowledge and influence” in the country’s mental and general health structures. In some of the countries, China, for example, the project has benefitted from the connections and experience of psychiatry residents and early career psychiatrists who participate in the Washington Psychiatric Society’s Career, Leadership, and Mentorship program.

He noted that the project recently applied for grant funding under the aegis of the Pan American Health Organization and World Health Organization Section for the Americas to take it beyond the pilot stage and expand its scope in three additional countries—Honduras, Nicaragua, and Jamaica. In those countries the goal will be to compare collaborative care for comorbid depression and certain physical illnesses with “care as usual,” Sorel said. Patients will be screened for depression in primary care settings using the PHQ-9 and for other illnesses using inventories addressing those conditions, as has been done in the countries in the pilot phase, he said, noting that he will be going to all of the countries as a technical advisor and project investigator.

A pilot project on depression screening in primary care involving Pretoria, South Africa, and Washington, D.C., will begin later this year, Sorel said.

“The Depression Screening in Primary Care project hopes to enrich scientific evidence on this subject. In turn, it will generate country-specific programs that will be catalytic in enhancing access and quality of care, diminish stigma discrimination against mental illness and those suffering from it, stimulate new education and training programs, improve health systems performance through collaborative and integrated care, and influence national health policies,” Sorel said. ■