Annual screening day focuses on depression

Primary care outreach program is designed to help physicians incorporate mental health screening tools into their practices.

By Stephanie Stapleton, amednews staff. Sept. 10, 2001.

Washington -- An estimated 19 million Americans experience depression each year. And a large percentage -- some of whom have regular contact with a physician -- go undiagnosed and untreated.

Douglas Jacobs, MD, a psychiatrist and clinical professor at Harvard Medical School in Boston, wanted to reverse this trend. His idea was to apply the screening methods used in medicine and public health to mental disorders -- to identify, for instance, those patients at risk for depression the same way patients' risks are assessed for medical illnesses such as diabetes or high cholesterol.

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Out of this concept grew National Depression Screening Day, a now annual event that provides screening tools to physicians, mental health professionals and a whole range of health care organizations. In the past years, between 1,000 and 4,000 doctors have participated.

Although the official screening day is set for Oct. 11, primary care physicians are encouraged to incorporate the screening activities into their practice any day in October or November. The AMA, as well as other organizations such as the American College of Physicians--American Society of Internal Medicine and the American College of Obstetricians and Gynecologists, is a sponsor of the initiative's primary care outreach program.

"The idea is that eventually screening for depression will become like taking someone's blood pressure," said Dr. Jacobs.

Diagnosis still elusive

Although 80% of depressed people can be effectively treated, nearly two out of three of those who experience depression do not seek or receive appropriate treatment.

In addition, clinical depression often occurs in association with other illnesses. In primary care, this incidence rate is between 5% and 10%. Among medical inpatients, it is between 10% and 14%. According to an initiative fact sheet, there is evidence of strong associations between depression and asthma, heart disease, diabetes, cancer, HIV and even osteoporosis.

Research has also shown that overall health outcomes are best when the depression is treated. Early detection and treatment has also been related to improved treatment compliance.

In terms of being aware of depression, "the majority of primary care physicians do a good job," said Dr. Jacobs. But there are many reasons why depression diagnoses elude them.

"We are in the age of specialization," he said. "Primary care physicians are aware of emotional problems but tend to focus on medical problems. That's their area."

In addition, symptoms masquerade as other problems -- sleep disorders, stomach ailments, complaints of low energy. These are all issues that can be attributed to organ-system difficulties, he added. "The patient is also less willing to acknowledge that they may be depressed," Dr. Jacobs said. "They want the problem to be something medical."

But a large number of physicians who participated in past years reported that the screening brought to light patients whose depression would have otherwise gone unreported. "It can be eye-opening," Dr. Jacobs said.

That was the experience of Robert Martin, MD, an internist in Lancaster, Pa., who participated in the screening day a year ago.

Dr. Martin said using the patient screening questionnaire increased his awareness and also provided him confirmation about the signals of depression. For one patient he saw that day, the process "opened the door to a diagnosis and led to an intervention."

Overall, patients were very open to participating, too, Dr. Martin said. Rather than view it as paperwork, they saw it as a plus. "They had an improved sense of comprehensive care."

It was a positive experience for his office nurse, too, who was very involved in the process. On average, according to National Depression Screening Day staff, the screening tool -- a patient questionnaire -- requires only three extra minutes for implementation into regular routines.

Data collected from 1999 indicated that 90% of clinicians participating found it helpful and 60% reported that some patients' symptoms would have otherwise gone undetected.