It’s perfectly normal to have feelings of sadness, anxiety or helplessness at times, especially after stressful moments. But these feelings fade, often within a few days, and rarely interfere with our daily lives.
For an estimated 16 million adults in the U.S. who experience episodes of depressive disorder, the opposite is true—these feelings become long-term symptoms that can interfere with work, sleep, relationships and the ability to enjoy once pleasurable activities. Depression can affect anyone, but women and the elderly are more vulnerable. Women in particular are 70 percent more likely than men to be affected during their lifetime, and an estimated 10 to 15 percent of women experience postpartum depression after birth.
With the aim of easing the burden placed on society by depression, the U.S. Preventive Services Task Force (USPSTF) issued a statement today that recommends screening for depression in the general adult population, including the elderly, pregnant and postpartum women. The report, published in the Journal of the American Medical Association, presents evidence that screening and early detection, when combined with appropriate treatment and follow-ups, can reduce or eliminate the symptoms of depression.
We spoke with Pooja Dave, PhD, integrated primary care postdoctoral fellow with the department of Psychiatry and Behavioral Neuroscience, about these new recommendations.
UChicagoMed: What do you think about screening for depression in the general adult population?
Pooja Dave: Early detection and intervention are effective in reducing depression, and the benefits of the USPSTF’s recommendation have minimal to no risks for patients. It’s fully consistent with the literature in this area and speaks to the importance of improved screening for depression and access to care.
How exactly will this help?
Patients are often more comfortable talking to their primary care doctors about depression before they consult with mental health professional. In fact, a recent study found that 70 to 80 percent of antidepressants are prescribed in primary care settings. However, primary care physicians are not often extensively trained in biopsychosocial considerations.
Standard screening measures allow them to better detect depression and decrease the risk of a missed diagnosis. The screening measures pointed out by the report have been developed for primary care settings and are designed to detect depressive symptoms among these patients. Additionally, they are brief and easy to administer. While screening does not provide information for more detailed mental health diagnoses, it can identify individuals who are at risk and may need more specialized mental health services. We know that treatments for depression are effective, and there are a number of evidence-based pharmacological and psychotherapeutic options available to these individuals.
What should women and older adults know about this report?
Older adults and pregnant/postpartum women are high-risk groups for developing depression. These individuals may also have some physical symptoms of depression that could be attributed to other medical causes and therefore might be missed. Because of this, early identification of mental health problems is extremely important and will improve access to care for these groups.
Pregnant and postpartum women are especially vulnerable patient populations. They should not feel shy about discussing symptoms of depression with their physicians who can also discuss treatment options for depression with them. They should know that there are some very effective and, more importantly, safe pharmacological interventions available. Non-pharmacological approaches such as cognitive-behavioral therapies have also been shown to be quite effective with these patients.
Is general screening for depression practical?
Yes, these are brief measures. They are self-report forms and can alert the physician to the need for referrals or pharmacological intervention as necessary. Patients can fill these out while they are waiting to see the provider or they can be administered by nursing or administrative staff.
What are the challenges involved in implementing these recommendations?
There are a lot of best practice mandates that primary care physicians are required to address in every clinic visit. This recommendation presents another mandate that they must fit into the standard 20 to 30-minute visit, which could add to their already considerable time pressures. In addition, when screenings are positive, these doctors may not have adequate information on how to make appropriate referrals for mental health care or how to proceed with treatment. Access to psychiatric care is a challenge in the US, and integrated primary care models are attempting to address these problems.
Are there any possible negative consequences for general screening?
There is the potential for over-diagnosis of depression, which may increase inappropriate referrals and patient confusion. But integrated care models are addressing this issue by including mental health professionals as part of the medical team. An integrated approach can also have the added benefit of reducing stigma toward mental health diagnoses and increase the likelihood that patients will follow through with referrals for specialty mental health if needed.