Primary Care Physicians Should Screen Patients for Depression, Task Force Says
The U.S. Preventive Services Task Force yesterday recommended that primary care doctors begin screening all adult patients for depression, noting that more than half of all cases of depression are undiagnosed or mistreated, the Washington Post reports. Up to 19 million American adults are thought to have depression, but as many as 67% of them do not seek treatment. The panel, an independent group of "highly influential" scientists who set "widely followed" standards of care, recommended the guidelines for primary care doctors because two-thirds of patients with depression are treated in primary care settings, and primary care physicians also see most patients whose depression goes undiagnosed (Vedantam, Washington Post, 5/21). The panel, which has no regulatory authority, in 1996 identified depression as "an important clinical problem" but did not make any recommendations regarding screening. However, after finding new evidence from several studies on the effectiveness of screening and intervention methods, the panel devised a set of recommendations (De Lisser, Wall Street Journal, 5/21).
The panel has suggested that primary care physicians ask all patients two questions: "Over the past two weeks, have you felt down, depressed or hopeless?" and "Over the past two weeks, have you felt little interest or pleasure in doing things?" If a patient answers yes to either question, the doctor should follow up with a "more specific" written or oral questionnaire intended to determine if the problems are long-term or fleeting, the panel recommended. The panel maintains that its suggestions could help identify as many as 90% of people who have major depression. The panel noted, however, that "screening is only the first step" toward treatment. "You have to have access to the right therapy or medicines," Alfred Berg, a professor at the University of Washington in Seattle and the chair of the task force, said, adding that doctors should follow up with a phone call or an additional visit to ensure that the prescribed treatment plan is being followed. The panel's recommendations could "add millions" to the ranks of people taking antidepressants such as Prozac, Paxil or Effexor, the Post reports. An analysis of the issue by Michael Pignone, a University of North Carolina researcher, is in today's Annals of Internal Medicine (Washington Post, 5/21).This is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.