Regular depression screening may identify patient populations with undiagnosed conditions

According to a new study, screening for depression in primary care settings could significantly enhance the likelihood that those who are typically undertreated — people of colour, seniors, people who speak little English, and men — will receive treatment.
According to a new study done by UC San Francisco, screening for depression at the primary care level could significantly enhance the possibility that those who are typically undertreated — people of colour, older adults, those with limited English proficiency, and men — will receive treatment.

Studies have indicated that depression is underdiagnosed in more than half of patients who appear with symptoms in primary care, where an estimated 60% of patients receive depression treatment, making it the second greatest cause of disability after cardiovascular illness.

Over a two-year period, the researchers monitored the electronic health records of 52,944 adult patients examined at six UCSF primary care facilities. Depression screening rates more than quadrupled following the implementation of a routine screening strategy, rising from 40.5% in 2017 to 88.8% in 2019, according to the researchers’ findings, which was published in JAMA Network Open on August 18, 2022.

They discovered that in 2018, 75 people aged 75 and older were likely to have a depression screening for every 100 patients between the ages of 18 and 30.

There were 59 Chinese-speaking patients and 55 other non-English language patients who were likely to be screened for depression for every 100 English-speaking white patients.

For elderly patients, Black/African Americans, other English-speaking patients, and patients with language challenges, statistically significant differences had almost entirely vanished by 2019. Males were nonetheless examined less frequently than women, with 87 men expected to receive a depression screening for every 100 women, up from 82 men prior to the implementation of the programme.

First author Maria E. Garcia, MD, an assistant professor in the UCSF Division of General Internal Medicine and the Department of Biostatistics and Epidemiology, said, “Our study is the largest since 2016, when the U.S. Preventive Services Task Force recommended that adult patients be screened for depression, and the first to investigate patient predictors of screening.” Implementing frequent depression screening could potentially enhance patient outcomes for consequences from other ailments because depression affects so many other chronic diseases.

The patients’ average age was 49, 59% of them were female, 43% of them spoke English, 25% of them were Asians, 9% were Latinos, 7% were Black, 1.4% were Pacific Islanders, 0.3% were American Indians or Alaska Natives, and 5.5% had linguistic problems. For 9% of English-speaking patients, race and ethnicity information was either missing or unknown.

Leah S. Karliner, MD, a professor in the UCSF Division of General Internal Medicine and the study’s principal author, said, “Our study demonstrates that a systems-based strategy can enhance depression screening and reduce screening inequities.

The authors claimed that a number of elements helped to achieve high, more equitable screening rates.

Depression screening was prioritised during the study period as part of a larger focus on quality improvement metrics across California’s safety net programmes that were connected to state monies; this gave primary care practises access to resources.

In addition, the healthcare system assembled a task group to detect screening inequities in clinical settings, with participation from all primary care offices. There was a multilingual primary care team on hand, as well as translators and multilingual screening equipment.

“To reduce care inequities, depression screening is required but insufficient. Screening may assist in improving a doctor’s ability to recognise depressed symptoms, but clinical action must come next “added Garcia. Future analyses will focus on whether screening increases the diagnosis, treatment, follow-up, and remission of depression, she noted.

Journal Reference:

Maria E. Garcia, Ladson Hinton, John Neuhaus, Mitchell Feldman, Jennifer Livaudais-Toman, Leah S. Karliner. Equitability of Depression Screening After Implementation of General Adult Screening in Primary Care. JAMA Network Open, 2022; 5 (8): e2227658 DOI: 10.1001/jamanetworkopen.2022.27658


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