Editor-in-Chief, Care for Your Mind
October 11, 2018 marks National Depression Screening Day, a prompt for people with concerns about their mental wellbeing to take advantage of nearby in-person screening opportunities and get connected to local resources. Participating in a screening day made all the difference for 25-year-old Monica, whose mother told her to go take a screening or she’d take her there herself.
The U.S. Preventive Services Task Force (USPSTF) makes recommendations, based on an assessment of available evidence, on addressing health issues such as screening for depression in clinical practice. Knowing that screenings are an effective process for detecting depression and that earlier interventions tend to work more quickly and more effectively, are we doing enough to support the widespread and liberal use of mental health screenings?
Here we highlight the USPSTF depression screening recommendations along with previous Care for Your Mind (CFYM) posts that advance those conversations. You’ll also find external links to outside resources and readings. Talk with people you care about on this National Depression Screening Day.
Expectations in Primary Care
Although there are a number of validated tools for screening and monitoring depression, in studies primary care providers did not detect major depressive disorder in one-half to two-thirds of patients who were then diagnosable. How often should primary care providers screen for depression? Although guidelines exist, there seems to be a gap between recommendations and practice.
Depression continues to rank as a leading cause of disability, resulting in personal, interpersonal, financial, and other harms to individuals, families, and society. Here on CFYM, Dr. Michael Thase advocated for mandatory mental health screenings in primary care and Dr. David Katzelnick likened depression screening to taking a person’s blood pressure as a means of gathering data about health status. Could it really be that easy?
Primary care is increasingly integral to the delivery of mental health care and, sadly, the vast majority of suicide attempts occur within a month of a visit to a healthcare provider. The most commonly-cited impediments to regular mental health (particularly depression) screening in practice include lack of time, lack of compensation, and cultural issues. These issues require leadership and change on a variety of fronts: among health professional organizations, insurers, federal and state health and licensing officials, medical educators, and even practice managers, healthcare providers, patients, and families.
See Michael E. Thase, MD, Faster and Easier Approaches for Improving Patients’ Depression Treatment Outcomes and David Katzelnick, MD, What Role Do Patients Play in Improving Quality of Care? A Big One.
Children and Adolescents
Screenings are useful for early identification of children and adolescents experiencing depression. The USPSTF recommends that adolescents and children ages 12 through 18 be screened for major depressive disorder, but makes no recommendation for children ages 11 and under, citing a lack of evidence to assess the benefits and harms of screening in that population. These recommendations endorse the American Academy of Pediatrics (AAP) promotion of universal screening for children ages 12 and above. The AAP published updated guidelines on teen depression earlier this year.
Among preteens, adolescents, and young adults (for all age groupings from ages 10 through 24 for these purposes, though actually through age 34), suicide is the second-leading cause of death. Would school-based screenings, particularly in middle and high school, help to identify and support young people in need of mental health interventions and turn the tide on youth suicide? What should pediatricians do in their practices?
See Donna Harland Barnes, PhD, Why Are Children Taking Their Own Lives? What Can We Do? and the post, Should We Screen Middle and High School Students for Mental Health Disorders?
Pregnant and Postpartum Women
The USPSTF draft recommendation indicates that clinicians should provide or refer pregnant and postpartum women who are at increased risk of perinatal depression to counseling interventions. The public comment window closed on September 24, 2018, so we await the final recommendation.
Meanwhile, advocates like Joy Burkhard, MBA, at 2020 Mom sees universal screening as an essential part of maternal health. Screening for maternal depression was included in the 21st Century Cures Act, which was signed into law on December 13, 2016. Last month, the U.S. Health Resources and Services Administration awarded seven states (FL, KS, LA, MT, NC, RI, VT) a total of $4.5 million to implement the Screening and Treatment for Maternal Depression and Related Behavioral Disorders Program. The aim is to eventually institute proven maternal mental health programs (like the Massachusetts MCPAP for Moms) across the country.
See the interview with Dr. Nancy Byatt, Post-Partum Depression: The Broader Picture; Why Doctors Can’t Treat Their Patients: Barriers to Mental Health Care for Obstetricians, Pediatricians, and Psychiatrists by Dr. Tiffany Moore Simas and Dr. John Straus; Everyone Can Be an Advocate! by Joy Burkhard; and comments by U.S. Representative Katherine Clark and Massachusetts State Representative Ellen Story in How Legislation Can Change the Face of Perinatal Mental Health.
The USPSTF recommends screening for depression in the general adult population and that adequate systems should be in place to ensure accurate diagnosis, effective treatment, and appropriate follow-up. By providing depression screening for annual examinations and sick visits (even where the complaints are not mood related), clinicians help to reduce stigma, normalize conversations about mental health, and identify depression so that people can access care sooner.
See previous Care for Your Mind posts, including How Can Mental Health Screening Help? and Reducing the Suicide Rate Among Middle-Aged Men in Massachusetts contributed by Screening for Mental Health; Where We Are With Mood Disorders, Part 1 with Dr. Scott Aaronson; What’s the State of Your State’s Mental Health and Care? by Theresa Nguyen, LCSW, of Mental Health America; and Angela Mattson’s What Does Integrated Care Actually Look Like?
Free Screening, Whatever the Date
Remember, free anonymous and confidential screenings are always available online. Visit www.familyaware.org/moodtest for the depression and bipolar disorder test. Visit www.helpyourselfhelpothers.org for additional mental health screenings.
Editor’s Note: If you or someone you care about is suicidal, get help immediately. The National Suicide Prevention Lifeline is available 24/7/365 at 1-800-273-8255. You can reach the Crisis Text Line by texting START to 741741. And you should be able to get care at your local hospital emergency department, no appointment required. Do not wait, get the support you need today.
What do you think?
- What should be done to support more consistent use of depression screenings by primary care providers?
- What has been your experience: how often does your PCP use a screening test to assess your depression level? Has it been helpful?
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- U.S. Agency for Healthcare Research and Quality, Depression Screening Fact Sheet and Resources
- Institute for Clinical Systems Improvement, Depression, Adult in Primary Care and Depression Suspected
- J. Unützer, MD, MPH, MA and M. Park, PhD, Strategies to Improve the Management of Depression in Primary Care
- Douglas M. Maurer, DO, MPH, Screening for Depression
- R.A. Zuckerbrot, A. Cheung, P.S. Jensen, R.E.K. Stein, D. Laraque, GLAD-PC Steering Group, Guidelines for Adolescent Depression in Primary Care (GLAD-PC): Part I. Practice Preparation, Identification, Assessment, and Initial Management and Part II. Treatment and Ongoing Management
- Centers for Disease Control and Prevention, Guidelines for Mental Health Screening during the Domestic Medical Examination for Newly Arrived Refugees
- U.S. Substance Abuse and Mental Health Services Administration, Infant and Early Childhood Mental Health Consultation, Maternal Health
- Screening for Mental Health