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Yield of Practice-Based Depression Screening In VA Primary Care Settings

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Abstract

Background

Many patients who should be treated for depression are missed without effective routine screening in primary care (PC) settings. Yearly depression screening by PC staff is mandated in the VA, yet little is known about the expected yield from such screening when administered on a practice-wide basis.

Objective

We characterized the yield of practice-based screening in diverse PC settings, as well as the care needs of those assessed as having depression.

Design

Baseline enrollees in a group randomized trial of implementation of collaborative care for depression.

Participants

Randomly sampled patients with a scheduled PC appointment in ten VA primary care clinics spanning five states.

Measurements

PHQ-2 screening followed by the full PHQ-9 for screen positives, with standardized sociodemographic and health status questions.

Results

Practice-based screening of 10,929 patients yielded 20.1% positive screens, 60% of whom were assessed as having probable major depression based on the PHQ-9 (11.8% of all screens) (n = 1,313). In total, 761 patients with probable major depression completed the baseline assessment. Comorbid mental illnesses (e.g., anxiety, PTSD) were highly prevalent. Medical comorbidities were substantial, including chronic lung disease, pneumonia, diabetes, heart attack, heart failure, cancer and stroke. Nearly one-third of the depressed PC patients reported recent suicidal ideation (based on the PHQ-9). Sexual dysfunction was also common (73.3%), being both longstanding (95.1% with onset >6 months) and frequently undiscussed and untreated (46.7% discussed with any health care provider in past 6 months).

Conclusions

Practice-wide survey-based depression screening yielded more than twice the positive-screen rate demonstrated through chart-based VA performance measures. The substantial level of comorbid physical and mental illness among PC patients precludes solo management by either PC or mental health (MH) specialists. PC practice- and provider-level guideline adherence is problematic without systems-level solutions supporting adequate MH assessment, PC treatment and, when needed, appropriate MH referral.

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Acknowledgments

This project was funded by the Department of Veterans Affairs (VA) Health Services Research and Development (HSR&D) Service and the Quality Enhancement Research Initiative (QUERI) (Project #MHI 99–375 and MNT 01–027). The manuscript reflects baseline data from a group randomized trial (Trial Registration No. NCT00105820). Dr. Yano is funded under a VA HSR&D Research Career Scientist award (Project #05–195). Dr. Campbell was funded by a VA Office of Academic Affiliations (OAA) Associated Health Postdoctoral Fellowship Program at the Northwest Center for Outcomes Research at the time the study was conducted; he is now Assistant Professor at the University of Montana.

We would like to acknowledge key intervention team members, including Susan Vivell, PhD, MBA, and Brad Felker, MD, as well as project support staff, Carol Simons, Laura Rabuck, MPA, and Debbie Mittman, MPA. Special recognition goes to the frontline efforts of the original network-level depression care managers, including Karen Vollen, RN, Barbara Revay, RN, and Bill Raney, as well as the site principal investigators at participating facilities.

An earlier version of this work was presented as a poster at the national meeting of the Society for General Internal Medicine (SGIM), New Orleans, LA, May 13, 2005.

The views expressed in this article are those of the authors and do not necessarily represent the views of the Department of Veterans Affairs or the United States government.

Conflict of Interest

None disclosed.

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Authors and Affiliations

  1. VA Greater Los Angeles Center of Excellence for the Study of Healthcare Provider Behavior, VA Greater Los Angeles Healthcare System, Sepulveda, CA, USA

    Elizabeth M. Yano PhD, MSPH, Ruth Klap PhD, Barbara F. Simon MA, Andrew B. Lanto MA & Lisa V. Rubenstein MD, MSPH

  2. Department of Health Services, UCLA School of Public Health, Los Angeles, CA, USA

    Elizabeth M. Yano PhD, MSPH & Lisa V. Rubenstein MD, MSPH

  3. Northwest Center for Outcomes Research, VA HSR&D Center of Excellence, VA Puget Sound Healthcare System, Seattle, WA, USA

    Edmund F. Chaney PhD & Laura M. Bonner PhD

  4. University of Washington, Seattle, WA, USA

    Edmund F. Chaney PhD & Laura M. Bonner PhD

  5. Department of Psychology, University of Montana, Missoula, MT, USA

    Duncan G. Campbell PhD

  6. Department of Medicine, VA Greater Los Angeles Healthcare System, Sepulveda, CA, USA

    Lisa V. Rubenstein MD, MSPH

  7. Department of Medicine, UCLA School of Medicine, Los Angeles, CA, USA

    Lisa V. Rubenstein MD, MSPH

  8. RAND Health, Santa Monica, CA, USA

    Lisa V. Rubenstein MD, MSPH

Authors
  1. Elizabeth M. Yano PhD, MSPH
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  2. Edmund F. Chaney PhD
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  3. Duncan G. Campbell PhD
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  4. Ruth Klap PhD
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  5. Barbara F. Simon MA
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  6. Laura M. Bonner PhD
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  7. Andrew B. Lanto MA
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  8. Lisa V. Rubenstein MD, MSPH
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Corresponding author

Correspondence to Elizabeth M. Yano PhD, MSPH.

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Yano, E.M., Chaney, E.F., Campbell, D.G. et al. Yield of Practice-Based Depression Screening In VA Primary Care Settings. J GEN INTERN MED 27, 331–338 (2012). https://doi.org/10.1007/s11606-011-1904-5

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