Study Finds Routine Depression Screening May Address Underdiagnosed Patient Populations

A new study led by University of California San Francisco (UCSF) showed that screening for depression at the primary care level could dramatically increase the likelihood of treatment for those who are traditionally undertreated, such as among racial and ethnic minority individuals, older adults, those with limited English proficiency, and men.

Depression tends to go unrecognized in more than half of patients presenting with symptoms in primary care, although data show that an approximate 60% of patients receive their depression care from the primary care setting.

Over a period of 2 years, the electronic health data of 52,944 adult patients seen at 6 UCSF primary care facilities was tracked by researchers. It was reported that after a routine screening policy was implemented, depression screening rates more than doubled, from 40.5% in 2017 to 88.8% in 2019.

In 2018, the research team found that for every 100 patients between the ages of 18 and 30 years screened for depression, 75 patients aged 75 years and older were likely to be screened for depression. Further, for every 100 English-speaking White patients screened for depression, there were 59 non-English-speaking patients likely to be screened for depression.

However, statistically significant disparities seemed to virtually disappear among older patients, African Americans, other English-speaking patients, and patients with language barriers by 2019. Screening for men remained relatively low, and for every 100 women screened for depression, 87 men were likely to be screened for depression.

“Our study is the largest since 2016, when the US Preventive Services Task Force recommended that adult patients be screened for depression, and the first to investigate patient predictors of screening,” said first study author Maria E. Garcia, MD, MPH, MAS, assistant professor in the UCSF Division of General Internal Medicine and the Department of Epidemiology and Biostatistics, in a press release. “Because depression impacts so many other chronic diseases, implementation of routine depression screening could also improve patient outcomes for complications from other conditions.”

The data showed that the average age of the patients was 49 years. Additionally, 59% of the patients were female, 43% English-speaking and White, 25% English-speaking and Asian, 9% Latino, 7% Black, 1.4% Pacific Islander, 0.3% American Indian/Alaskan Native, and 5.5% were patients with language barriers. There was missing or unknown data for race and ethnicity for 9% of the English-speaking patients.

“Our study shows that a systems-based approach can increase depression screening and address screening disparities,” senior author Leah S. Karliner, MD, professor in the UCSF Division of General Internal Medicine, said in the press release.

The study authors noted that several factors contributed to achieving high, more equitable screening rates. During the study, depression screening was a priority as part of a larger focus on quality improvement metrics across safety net systems in California tied to state funds. In addition, the health care system created a task force with representation from all primary care practices focused on detecting screening disparities in clinical settings.

“Depression screening is necessary, but not sufficient, to decrease care disparities,” Garcia said in the press release. “Screening may help with poor physician recognition of depressive symptoms, but it must be followed by clinical action.

According to Garcia, future investigations will be focused on whether screening is associated with increases in depression diagnosis, treatment, follow-up, and remission.

REFERENCE

Routine Depression Screening May Capture Underdiagnosed Patient Populations. UCSF. August 18, 2022. Accessed August 23, 2022. https://www.ucsf.edu/news/2022/08/423496/routine-depression-screening-may-capture-underdiagnosed-patient-populations