Primary Care Doctors Are Missing Red Flags for Depression

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.”

Reference:
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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  • sutton

    sutton

    March 15th, 2013 at 3:46 AM

    Okay we can’t have it both ways. Proimary doctors are simply overwhelmed- they have so much on their plates that it is hard for them to catch all of the red flags. And aren’t all of the pros in the mental health community always saying that they don’t want general practice doctors treating depression in the first place? You can’t say that they are falling down on their jobs when the consensus seems to be that you don’t want them treating these patients anyway. How about looking to the lack of resources available to the people who might need a depression screening instead of to docors who are already overwhelmed?

  • Irena T

    Irena T

    March 16th, 2013 at 6:16 AM

    I hear that we want more people who are experiencing symptoms of depression to get treatment, and I agree with that assessment.

    But is this really where we want them to have to rely on for their care? A community health center that may be staffed by people who have no real idea about the depth and the breadth that depression can encompass and the numerous ways to battle depression? There has to be a better way to get care and proper treatment to this segment of the population.

    Forcing them to rely on just any provider is not the answer.

  • FT

    FT

    March 16th, 2013 at 11:42 PM

    Very imp for these docs to be in their toes.these folks cannot go to a specialist so chances are the disorder could go undisguised and something preventable could cause a lot of problems down the road.its a safekeeper’s job-often thankless and heavy-but someone’s gotta do it!

  • dorothy

    dorothy

    March 18th, 2013 at 4:01 AM

    But if their patients are withholding information then how are they even supposed to know to screen for this?

  • john v

    john v

    March 19th, 2013 at 3:55 AM

    A good doctor, no matter his or her area of specialty will see when this could be a concern for one of their patients. Sometimes all you have to do is have a little conversation with people and you can tell a good bit about how they feel and how they are reacting to the things going on in their lives. And for a lot of older patients this could be a good thing, having this treated by the GP, because this is likely who they see for many of their problems, so therefore this is a doctor who is familiar with their case, all of the other meds that they are taking, and how they may best respond to treatment. If the doctors are paying attention I think that they could be a great primary resource for depression treatment for many of these patients.

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