Screening Your Adult Patients for Depression
Family physicians are well-placed to catch depression in patients early – and get reimbursed for it.
Fam Pract Manag. 2016 Mar-Apr;23(2):16-20.
Author disclosures: no relevant financial affiliations disclosed.
Although depression screening is not new for many family physicians, the United States Preventive Services Task Force (USPSTF) in January recommended expanding those screens to most adult patients, with a particular focus on women in the peripartum period.1 Prior recommendations had suggested screening only when staff resources were sufficient to provide support and treatment; however, the USPSTF has concluded that mental health supports are now more widely available than in 2009 when the previous recommendation was made.
The USPSTF is an independent, volunteer panel of national experts that makes evidence-based recommendations about clinical preventive services such as screenings, counseling services, and preventive medications. Following a review of the available evidence, the USPSTF assigns one of five letter grades (A, B, C, D, or I) to a recommendation. Grade A and B recommendations represent services with high or moderate evidence to support their use. Depression screening in adults and adolescents is a grade B recommendation, meaning there is high certainty that the net benefit of depression screening is moderate or there is moderate certainty that the net benefit is moderate to substantial.2
Family physicians should be aware of this grading system, as evidence-based screenings with USPSTF A or B grades are covered services under the Patient Protection and Affordable Care Act.1 In addition, an increasing number of physician quality programs, including the Centers for Medicare & Medicaid Services' (CMS) Physician Quality Reporting System (PQRS), now use depression screening as a quality indicator. In 2015, Medicare's PQRS program expanded the depression quality metric to include treatment and remission.3
Why screen for depression?
Depression is very common in the United States. Between 2009 and 2012, 8 percent of people 12 years of age and older reported having depression for a two-week period.4 Major depressive disorder is listed as the primary diagnosis for 8 million ambulatory visits to physician offices, hospital outpatient clinics, and emergency departments and for 395,000 inpatient visits.5 Yet we know that the effect of depression on chronic medical disease management is grossly underestimated. Patients with depression experience a higher incidence of premature death related to cardiovascular disease and are 4.5 times more likely to suffer a myocardial infarction than those without depression.6 The costs of depression extend past the obvious emotional, mental, and physical burden on an individual person.
In 2000, the total economic burden of depression was an estimated $83 billion, and the majority was related to lost workplace produc
Referencesshow all references
1. United States Preventive Services Task Force (USP-STF). Final Recommendation Statement – Depression in Adults: Screening. January 2016. http://www.uspreventiveservicestaskforce.org/Page/Document/RecommendationStatementFinal/depression-in-adults-screening1. Accessed Feb. 2, 2016....
2. Grade definitions. USPSTF website. http://www.uspreventiveservicestaskforce.org/Page/Name/grade-definitions. Accessed Feb. 2, 2016.
3. 2016 Physician Quality Reporting System measure codes. Centers for Medicare & Medicaid Services (CMS) website. https://www.cms.gov/medicare/quality-initiatives-patient-assessment-instruments/pqrs/measurescodes.html. Accessed Feb. 2, 2016.
4. Pratt LA, Brody DJ. Depression in the U.S. household population, 2009–2012. National Center for Health Statistics Data Brief, No. 172. Hyattsville, MD: NCHS; 2014. http://www.cdc.gov/nchs/data/databriefs/db172.pdf. Accessed Feb. 2, 2016.
5. FastStats: Depression. Centers for Disease Control and Prevention website. http://www.cdc.gov/nchs/fastats/depression.htm. July 2015. Accessed Feb. 3, 2016.
6. Halfin A. Depression: the benefits of early and appropriate treatment. Am J Manag Care. 2007;13(4 Suppl):S92–S97.
7. Greenberg PE, Kessler RC, Birnbaum HG, et al. The economic burden of depression in the United States: how did it change between 1990 and 2000? J Clin Psychiatry. 2003;64(12):1465–1475.
8. Druss BG, Rosenheck RA, Sledge WH. Health and disability costs of depressive illness in a major U.S. corporation. Am J Psychiatry. 2000;157(8):1274–1278.
9. Parker G. Is depression overdiagnosed? Yes. BMJ. 2007;335(7615):328.
10. Mojtabai R. Clinician-identified depression in community settings: concordance with structured-interview diagnoses. Psychother Psychosom. 2013;82(3):161–169.
11. Carlat DJ. The psychiatric review of symptoms: a screening tool for family physicians. Am Fam Physician. 1998;58(7):1617–1624.
12. Arroll B, Khin N, Kerse N. Screening for depression in primary care with two verbally asked questions: cross sectional study. BMJ. 2003;327(7424):1144–1146.
13. Telehealth services. CMS website. https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/downloads/TelehealthSrvcsfct-sht.pdf. December 2015. Accessed Nov. 4, 2015.
14. What are the reimbursement issues for telehealth? Health Resources and Services Administration website. http://www.hrsa.gov/healthit/toolbox/RuralHealthITtoolbox/Telehealth/whatarethereimbursement.html. Accessed Feb. 2, 2016.
15. Preventive services chart. CMS website. https://www.cms.gov/Medicare/Prevention/PrevntionGenInfo/Downloads/MPS-QuickReferenceChart-1TextOnly.pdf. October 2015. Accessed Feb. 2, 2016.
16. Aetna depression in primary care program. Aetna website. http://www.aetna.com/healthcare-professionals/documents-forms/depression-program.pdf. May 2015. Accessed Jan. 18, 2016.
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