For many individuals, the primary care doctor is the first, or only, medical profession they will see when they develop physical or mental health issues. For people with limited financial means and lack of insurance, community health centers (CHCs) provide affordable access to healthcare and may be the primary resource for medical or psychological services. The primary care doctors at CHCs are charged with identifying, diagnosing, and treating a range of issues, including physical illness, chronic illnesses, and mental health problems. Because they act as the gatekeeper for other avenues of treatment, it is essential that primary care doctors use every available tool to accurately assess their patients. In an effort to evaluate the effectiveness of depression diagnoses in CHCs, Ann H. Maradiegue of the School of Nursing and the College of Health and Human Services at George Mason University in Virginia recently analyzed the medical charts of 90 patients from a CHC. She looked to see if the markers for depression, the red flags of family history, chronic illness, socioeconomic disadvantage, and life stress, were being identified and charted.
Maradiegue discovered that for the most part, no routine screening for depression was being done on the patients. She also found that nearly half of the patients had no record of family history, suggesting that clinicians either did not ask about family history or did not chart it. When Maradiegue examined the charts herself she concluded that 48.9% of the patients at the CHC had red flags for depression. However, the only tests done were those for the identification and maintenance of chronic illness, including blood tests to measure blood sugar, cholesterol, and blood pressure.
These results may be worrisome. First, doctors in CHCs should recognize that they may be the only medical resource available to many individuals. Secondly, those with family history or other warning signs should be referred for psychological treatment in an effort to improve quality of life and decrease risk for suicide and other negative outcomes. Finally, for those with chronic illnesses, management and care for depression will not only increase their psychological well-being, but will also improve their own management of their illness and their overall physical health. Maradiegue hopes that these findings will motivate other researchers to devise methods to increase depression screening in CHCs. She added, “Further research is needed to determine how to best structure mental health interventions to meet the mental health needs of a diverse immigrant community.”
Ann, H. Maradiegue, and Fakiha Khan. Missed opportunities in primary care: The importance of identifying depression through screening, family history, and chronic disease management. Journal of Psychosocial Nursing & Mental Health Services 51.2 (2013): 27-36. ProQuest Research Library. Web. 6 Mar. 2013.
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