Every once in a while, a simple idea comes along that has the potential to bring enormous health benefits. Screening for depression is one of them. It is a low-cost, high-impact intervention that should be a regular part of primary care medicine.
This idea is not new, as we pointed out back in October of last year. But it’s gotten another helpful boost — and was in the news last week — because the U.S. Preventive Services Task Force (USPSTF) released updated recommendations reinforcing this message.
Depression is common and potentially disabling. Yet despite decades of research and publicity about the problem, depression often goes unnoticed. Unnecessary suffering can be prevented if the task force recommendations are followed:
- They encourage primary care practices to have systems to detect depression: Screening can be done with a simple questionnaire.
- If a person is diagnosed with depression, treatment can be offered: psychotherapy, medication, or a combination of the two.
- After initiating treatment, provide follow up: A phone call to the person and/or return visits to the primary care provider.
Screening can be as simple as a two-item questionnaire. The Patient Health Questionnaire-2 (PHQ-2) asks,
Over a 2-week period, have you been bothered by (1) little interest or pleasure in doing things; or (2) feeling down, depressed or hopeless?
Answering yes to either item means the problem should be evaluated more fully. The primary care provider may make a referral to a mental health provider, but there is enormous value when initial evaluation and treatment can begin in the primary care setting.
The task force focused special attention this time on women who are pregnant or who have recently given birth to a child. This is quite important because mood problems are surprisingly common during these periods. A majority of women experience transient changes in mood, but up to 15% of new mothers may experience significant depression during pregnancy or after the baby is born.
Anyone who is suffering should not debate what it means to have a “significant” mood problem. If you’ve gotten to the point of wondering about it, that’s the time to speak up, get support, and consider helpful options.
What I find heartening about the current report is its emphasis on matter-of-fact, achievable goals. Identification of mood problems and better access to support and treatment in primary care practices, can significantly improve outcomes for both mothers and children.