Dr Michael Thase: Screening for Depression Has to Be Coupled With Intervention

Screening for depression in the primary care setting can take as little as 30 seconds, but screening is only effective if it actually leads to intervention, explained Michael E. Thase, MD, professor of psychiatry and director of the Mood and Anxiety Program at the University of Pennsylvania. 

Last year, the US Preventive Services Task Force called for screening adults for depression. Is it happening as recommended? If not, why?
More people with depression are seeking care within the primary care sector than in secondary, tertiary care settings. So primary care settings are the place in order to recognize and get treatment started for depression. And in a majority of people, suffering from depression can be effectively treated in primary care. We did this giant study called STAR*D, and our primary care docs got the very same outcomes as the psychiatrists did with administering first-line treatments.

So screening is valuable and there is a 2-item screener. You know have to watch for so many things in primary care, but there's a 2-item screener that can be done in the waiting room that delivers high accuracy, high sensitivity. And of course it's not specific, but it's not supposed to be specific. And it really does take 30 seconds or less to tick off 2 items on the screener. If you're positive on one or the other, and that's a low mood and a loss of interest, then you go through the remaining 7 items to diagnose the depression. And if you have 3 or more of those remaining—5 or more total—then it really should be considered, the possibility of a depressive episode.

Now we've also learned that screening really falls short, unless it's coupled with ensuring that the screening action leads to intervention. And so at one point a care setting decided that they were going to stop screening because they couldn't guarantee that the screening would be followed up. Because we all know how much depression costs society, how it amplifies common chronic conditions, like diabetes, heart disease, we're now being reimbursed based on effective screening and effective treatment because it saves the healthcare setting money and it saves lives in the long run.
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