Depression screening guidelines were 'overdue,' experts say

Feb 4th, 2016

Article written by Heather Caspi and originally appeared in HealthcareDIVE Feb. 3

Following the recently expanded guidelines from the U.S. Preventive Services Task Force, which now recommends depression screening for all U.S. adults over the age of 18 as part of routine healthcare, including for pregnant and postpartum women, several experts told Healthcare Dive they agreed it was time.

Whether the recommendation will have much practical impact, such as spurring further integration of behavioral health with primary care, remains to be seen.

Pete Mumma, the system director of psychiatry and behavioral health at LifeBridge Health in Baltimore, Maryland, says it’s something he’s been advocating for the last decade. He works closely with the system’s population health department and notes that symptoms of depression—even if they aren’t severe enough to reach the threshold for a formal depression diagnosis—can still create barriers for a patient’s functionality and effective management of their other medical conditions.

“The presence of co-morbid symptoms of depression and other mental illness very much impact that patient’s wellness,” Mumma says. For example, depressive symptoms such as lack of concentration and motivation can make it difficult for a patient to adhere to a drug regimen.

He concedes primary care physicians have previously had good reasons not to take it on: lack of time, given the average medical visit is already too short at seven minutes; and lack of referrals or resources to do anything about the results.  

“That’s a very real concern,” Mumma says, “because there are access issues to psychiatric care in almost every part of the country.”

Despite that issue, however, Mumma argues that a simple screening for depression is very much akin to another vital sign.

“We need to identify what each person’s challenges are that prevent them from optimal wellness, and whether we screen for depression or don’t screen for depression, it’s still there in the patient,” he says. “In order to treat the whole patient we need all the information.”

As for whether the recommendation will spur behavioral and medical care providers to work more closely, Mumma says, “I think that’s happening already but I think it will drive a greater degree of integration.”

To help ease the screening process, Mumma promotes the practice of handing patients a tablet so they can privately enter their responses directly into their medical record. That can reduce the stigma patients feel compared to handing forms to staff, and it takes the burden off staff to find time to administer it or to address the subject during that visit.

Mumma adds that payer restrictions are the other major challenge because there’s no empirical test for depression. He hopes that by effectively mandating screening as best practice, depression treatment will become more broadly accepted.

Similarly, Dr. Nishendu M. Vasavada, a board-certified psychiatrist at Oceans Behavioral Hospital Plano and a distinguished life fellow of the American Psychiatric Association, says the recommendation has been overdue for the last 37 years—since the availability of screening tools. “Routine screening for depressive symptoms is appropriate and, frankly, it’s just the right thing to do,” he says.

He also believes the recommendation should prompt further steps toward the integration of behavioral and primary health. “Patients with psychiatric diagnoses are higher utilizers of medical care and often have poorer prognoses,” he says. “Ultimately, treating depression saves lives and money. The real cost of depression is from overutilization of medical services and loss of productivity, not to mention the cost to family life and risk of substance use.” 

A supporter from the primary care side is Dr. Harold Sirota, DO  FACOFP, chairman of the Department of Primary Care at Touro College of Medicine in New York.

He also considers the recommendations late in coming, and notes that many primary care physicians have already implemented depression screening in their practices. 

He sees insurance issues as the biggest barriers, from a lack of psychiatrists or behavioral health specialists available in patients’ provider networks, to a lack of reimbursement for the diagnosis of depression.

“With other diagnoses such as chest pain, a PCP can do the appropriate work-up, make referrals to a cardiologist and get reimbursed. With depression, this is not the case,” Sirota says.

“What is important is that depression exists, it is far more prevalent than previously realized, and we have a responsibility as PCPs to deliver quality care to our patients.”


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