Depression is common in primary care, though screening is often infrequent. Approximately, 15 million physician office visits document depressive disorders as a primary diagnosis and 11% indicate depression on the medical record. A 2010-2018 survey indicated 13.1% of primary care encounters involved depression diagnoses with screenings completed 4.1% of the time. Barriers previously identified in research include personnel trainings, perceived clinical relevance, reading and rephrasing questions, patient opinions on purpose of screening, patient cooperation, time constraints, and workflow inefficiencies. The aim of the project was to gain an understanding of medical residents and Advanced Practice Practitioners knowledge and utilization of depression screeners. Qualitative data was gathered via semi-structured focus group with interview led by first author documented using Otter.ai, an online transcription software. Participants included residents (n = 10) and advanced practiced practitioners (APPs; n = 6) in internal medicine. Residents and APPs were interviewed on two separate days. Transcripts from the interviews with the residents and the APPs were entered into ChatGPT to identify key themes and differences between the two transcripts. Key themes identified from both groups include inconsistent use and triggers for using screeners, workflow and systems barriers, concerns about validity and clinical usefulness, concerns for patient experience and comfort, concerns regarding safety and suicide risk screening, and thoughts about opportunities for improvement. Key themes and differences identified in this project can be useful when considering how we can provide education around depression screening and address areas of concern with residents and other healthcare providers.
Hobbs, C., Lewis, G., Dowrick, C., Kounali, D., Peters, T. J., & Lewis, G. (2021). Comparison between self-administered depression questionnaires and patients’ own views of changes in their mood: a prospective cohort study in primary care. Psychological Medicine, 51(5), 853–860. doi:10.1017/S0033291719003878 Background Self-administered questionnaires are widely used in primary care and other clinical settings to assess the severity of depressive symptoms and monitor treatment outcomes. Qualitative studies have found that changes in questionnaire scores might not fully capture patients' experience of changes in their mood but there are no quantitative studies of this issue. Researchers examined the extent to which changes in scores from depression questionnaires disagreed with primary care patients' perceptions of changes in their mood and investigated factors influencing this relationship. Methods Prospective cohort study assessing patients on four occasions, 2 weeks apart. Patients (N = 554) were recruited from primary care surgeries in three UK sites (Bristol, Liverpool and York) and had reported depressive symptoms or low mood in the past year [68% female, mean age 48.3 (s.d. 12.6)]. Main outcome measures were changes in scores on patient health questionnaire (PHQ-9) and beck depression inventory (BDI-II) and the patients' own ratings of change. Results There was marked disagreement between clinically important changes in questionnaire scores and patient-rated change, with disagreement of 51% (95% CI 46-55%) on PHQ-9 and 55% (95% CI 51-60%) on BDI-II. Patients with more severe anxiety were less likely, and those with better mental and physical health-related quality of life were more likely, to report feeling better, having controlled for depression scores. Conclusions Our results illustrate the limitations of self-reported depression scales to assess clinical change. Clinicians should be cautious in interpreting changes in questionnaire scores without further clinical assessment.
Jackson, J. L., Kuriyama, A., Bernstein, J., & Demchuk, C. (2022). Depression in primary care, 2010-2018. The American Journal of Medicine, 135(12), 1505–1508. https://doi.org/10.1016/j.amjmed.2022.06.022 Depression is common in primary care and significantly reduces quality of life. Our study aimed to examine the prevalence of depression in primary care visits, examine patterns of depression treatment and referral, and determine how often depression screening occurred over an 8-year timespan. From the 2010-2018 National Ambulatory Medical Care Survey, a national probability sample of non-federal, ambulatory encounters, we identified adults being seen in a primary care clinic. We assessed the prevalence of depression screening, diagnosis, and treatment. During these 8 years, 13.1% of primary care encounters involved a patient with a diagnosis of depression. The prevalence of depression did not change over time. Patients were screened for depression 4.1% of the time, with screening increasing over time. Depression was more likely to be diagnosed when screening occurred (odds ratio 9.9; 95% confidence interval, 6.8-14.5%). Most patients were treated with a selective serotonin reuptake inhibitor. Depression is common in primary care, though screening was infrequent. Practices should consider instituting universal screening.
Pilipenko, N., & Vivar-Ramon, C. (2023). Depression Screening Perceptions and Practices in a Primary Care Clinic: A Mixed-Methods Study. Psychological Services, 20(4), 756–763. https://doi.org/10.1037/ser0000753 Depression is highly prevalent in primary care (PC) settings. While extensive efforts are directed at optimization of depression screening practices, rates remain suboptimal, and barriers continue to be poorly understood. The present study investigated screening-related practices and beliefs. A concurrent mixed-methods approach was utilized to obtain both quantitative and qualitative data. Participants (N = 36) completed a self-report survey and a brief semistructured interview to assess attitudes toward depression screening, knowledge/beliefs about screening, as well as administration practices and screening-related training. Despite low rates of training (52.8%), participants endorsed understanding of the purpose, scope, and specialty populations targeted for screening. 83.3% of the sample assisted patients with screening completion. Rephrasing and reading the screening items were common and (with exception of reading the paper form) were associated with higher reported screening-related barriers (p < .05). Perceived importance of screening scores was significantly, positively associated with screening-related competence scores (r = .50, n = 35, p < .01). Qualitative data analysis revealed that screening may be conducted on a case-by-case basis or deferred based on perception of clinical relevance and time constraints. Finally, participants endorsed multiple screening-related questions and concerns about administration, psychometrics, and overarching screening goals. To improve implementation of universal depression screening, goals of depression screening need to be clearly explained. Screening workflows require optimization balancing employees' feedback and best practice recommendations. Impact Statement In a primary care clinic, depression screening was reported as a routine practice but conducted selectively: depending on perception of clinical relevance. Self-report screening was frequently not implemented as recommended-as providers routinely assisted with its completion. Rephrasing and reading the screening items were associated with greater reported screening barriers. Competence in screening administration and belief about its importance are also connected.