Identifying Depression: We Must Do More

Article excerpt

National Depression Screening Day is a great step forward. That's why I agreed to help screen potential patients during the 15th annual event last month at Lutheran Medical Center in New York City. After all, getting more involved in the early detection and prevention of depression can lead to a solid public health model of care, in which I am a firm believer.

On that day, Oct. 6, I worked with Jack Fitzpatrick, Ph.D., an experienced psychologist, and a younger colleague, Jacqueline Guajardo, Ph.D., in a screening area at Lutheran. We encouraged passersby to fill out the Patient Health Questionnaire (PHQ-2), a two-item screening test. Based on their responses, some were asked to complete the Patient Health Depression Questionnaire (PHQ-9), a nine-item instrument designed to identify depression.

When depression was noted, the person was invited to a private consultation with any of us doing the screening. If it was clear that the person had depression, an appointment was made for further evaluation and possible treatment. I like this approach. First, having people feel comfortable enough to discuss emotional disorders and receive care gets these patients closer to avoiding the pain and suffering that depression can cause.

We all know the pervasiveness of depression. Results of the National Comorbidity Survey Replication showed that 10%-40% of patients have significant depressive symptoms, and half of those patients do not meet the criteria for major depressive disorder based on the DSM-IV (JAMA 2003;289:3095-105). Other studies have found that when formal DSM-IV criteria are used, the prevalence of "minor" depression is about twice that of major depression (Int. J. Psychiatry Med. 1996;26:177-209).

Because our colleagues in primary care often see these patients first, it seems to me that they--whether they be family medicine doctors, internists, or pediatricians--should be able to identify depression first in these patients. Undoubtedly, gynecologists also come across patients with depression. And just as these providers focus on mammography, colonoscopy, and melanoma detection, they should be prepared to identify depression and provide subsequent care, including referrals.

In fact, Iraida Kazachova, D.O., a psychiatrist at Lutheran Medical Center, suggests that a depression screening and even a Mini-Mental State Exam should be part of every physical exam. …

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