Are Depression Screenings Occurring in General Practice?

According to the results of a recent study, general practitioners are not screening enough of their high risk patients for depression. The study, led by Bhautesh Dinesh Jani of the Institute of Health and Wellbeing at the University of Glasgow in Scotland was designed to determine how often individuals with chronic illness are screened for depression in general practice settings. Individuals with chronic illnesses have a high risk of developing depression and other mood issues.

Therefore, efforts to provide early identification and treatment of those at risk have been stepped up throughout the United Kingdom and across the globe. In Scotland, primary care doctors are encouraged to screen people with chronic illnesses for depression. But Jani wanted to find out if they were doing that, and if so, what was being down as a result of the screening.

Jani analyzed data from over 125,000 patients with any combination of diabetes, coronary heart disease, or stroke that saw their primary care doctor between 2008 and 2009. The data was examined for presence of a screening, level of symptoms and treatment outcome. Jani found that even though this early detection system has been encouraged, nearly 69% of all patients had no record of ever being screened for depression. It is unknown whether stigma, shame, or other barriers prevented this from occurring, but these factors should be looked at more closely.

Of all the patients in the study, 8.5% had already been diagnosed with depression. Out of the remaining group, 19.9% had elevated depressed symptoms that indicated a potential for mild depression. After six months, 8% of those with elevated depressed symptoms began antidepressant medication, and 2.4% with normal depression scores and no indication of depressed mood also started antidepressants. Although some research suggests that males are prescribed antidepressants more often than females, these results demonstrated just the opposite. In fact, middle aged females between the ages of 45 and 64 were most likely to be prescribed antidepressants.

In general, depressed mood and elevated depression scores were found in females more than males, in those with low incomes, in those under the age of 44, and in those with multimorbid conditions. Jani believes that this research shows that early screening and detection changes the course of routine treatment for chronically ill patients. “The key question will be to explore how such treatment changes affect outcomes, if at all,” said Jani.

Jani, B.D., Purves, D., Barry, S., Cavanagh, J., McLean, G., et al. (2013). Challenges and implications of routine depression screening for depression in chronic disease and multimorbidity: A cross-sectional study. PLoS ONE 8(9): e74610. doi:10.1371/journal.pone.0074610

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  • Traysie

    October 4th, 2013 at 3:41 AM

    Do we want these to be the doctors doing the screening? OK I can see them doing the initial screening but I think that it should then be referred out to another doctor or someone who specializes in that field of treatment.

    Don’t get me worng, these doctors know a lot, they have to to see the number of patients that they do, I just don’t think that they are trained enough to handle something specialized like depression.

  • jane

    October 4th, 2013 at 6:14 AM

    I think some things in life just make you that much more vulnerable to depression.And illness and not keeping well can be catalysts of course.So when someone with an illness is seeing a doctor it may well be assumed that it would be much better to have the person screened, at least on a basic level.

    To know that this is not happening is slightly unsettling. I mean not a lot of us are good symptom-readers to identify something and then go have ourselves checked.So a visit to a general practitioner could be what helps in this regard, to identify, to help us see.

  • jon s

    October 4th, 2013 at 10:18 AM

    If the family doctor is the first point of contact for so many patients, then yes, there definitely needs to be an increase in the number of patients being creened for depression, particularly those who are at high risk for it.

  • Olivia p

    October 5th, 2013 at 8:11 AM

    I often wonder if maybe patients are more inclined to talk about this if the doctor brings it up first.

    I think that there are those people who are going to be very hesitant to talk about depression and the things that they are feeling unless there is someone who asks a few questions and who tries to understand what is going on with them. I think that most of us can appreciate the time that a doctor takes with asking questions, and that makes us feel like he has our best medical interest in mind and is trying to come up with a comprehensive medical plan to cover all of our issues. If we are comfortable with our providers then this could also help to contribute to a better conversation with the doctors as well, hopefully giving them a much clearer picture of what is going on too.

  • brock

    October 7th, 2013 at 3:55 AM

    If doctors would just take an extra minute or two to sit and talk with their patients I think that they would be surpised at what they would hear. I think that you are spot on, especially the ones who are already dealing with illness in their lives, and if this has caused a major life change for them, then the doctor should know that there is a strong possibility that the patient could also be dealing with depression too. I think that this is probably often overlooked because the primary illness is being treated but then the things that happen afterward are ignored or overlooked. Often the patients don’t know to say anything because they don’t know if what they are feeling is caused from the primary illness or the medication or what; this is something that the doctors should definitely take a little more time with.

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