By Franklin Cook, SPNAC Editor
In a Huffington Post item today, titled “Let’s Not Get Too Depressed about Depression,” Dr. Lloyd Sederer, a psychiatrist and public health advocate, argues for a mandate that would do as much to prevent suicide as any other single action might accomplish:
One hundred percent of primary care practices .. should be screening for depression and using standardized treatment guidelines.
Dr. Sederer has a fairly straightforward plan to accomplish the nationwide screening he recommends.
Mental health has been losing in the competition for fair time and proper management without a numerical measure of a disease. How about starting with its poster child disease — depression — to remedy that?
The good news is that there is a simple, nine-item questionnaire called the PHQ-9 that someone can fill out in the waiting room, before seeing the doctor or nurse, that provides a highly reliable number that tells the doctor the likelihood (almost 90 percent sensitive) that you have a depression.
Of course, screening every visitor to a doctor’s office and then further assessing and effectively treating those who have depressive illness is a vast undertaking that would not be simple nor easy nor without cost. [Editor’s note: Please see Dr. DeQuincy Lezine’s comprehensive and insightful comment on this point.]
But we know that about 33,000 people a year die by suicide in the United States and that about half of them have a mood disorder (which implicates some type of depression in 16,000 suicides annually). So if depression is mental health’s “poster child disease” and it plays a role in 16,000 deaths every year, might not universal screening for depression in primary care be, as Dr. Sederer argues, a good starting place for prevention?
There are several models already available to move such an initiative forward. Here are two examples:
(1) The Three Component Model developed by the Macarthur Initiative on Depression and Primary Care is “a systematic approach” involving the “primary care clinician and practice, care management, and collaborating mental health specialist.”
The three components include elements shown to improve depression outcomes in recent randomized controlled trials. Telephone support for the depressed patient from a care manager is one central element as is periodic quantitative feedback about the patient’s response to treatment from the care manager to the clinician. The feedback is provided through depression severity scores based on PHQ-9. Another element is closer relationships between the primary care clinician and mental health specialists …
(2) The Suicide Prevention Toolkit for Rural Primary Care is an Internet-based resource containing “information and tools to implement state-of-the-art suicide prevention practices and overcome the significant hurdles this life-saving work faces in primary care practices.”
The Toolkit offers the support necessary to establish the primary care provider as one member of a team, fully equipped to reduce suicide risk among their patients. For instance, the tools will help you engage your patients and those around them in managing their own suicide risk. You’ll find tools for developing partnerships with mental health providers — regardless of how far away they may be — and a guide to developing telemental health services, a promising solution for many rural areas. There are also posters for display in your office, schools, and churches, and wallet cards listing warning signs for suicide and the number of the national crisis line.
[The abridged URL for this post is http://tinyurl.com/DepressionScreening .]