Utility of an intervention to detect depression in primary care

OBJECTIVE: To determine whether a 3-part intervention consisting of raising physicians’ awareness of depression, mass depression screening using a 2-item version of the Prime MD Questionnaire, and communicating the results of the screening to the physician, will improve detection and treatment of depression in a primary care setting.

METHODS: The study took place in Hilsboro, Oregon between July 1, 2001 and September 30, 2001. We distributed educational materials to the primary care physicians 2 months before screening patients. Over a 3 month period, 3431 consecutive patients who visited Tuality Health Care primary care clinics were screened using a 2-item version of the Prime MD depression-screening questionnaire. The primary care physicians conducted further assessment for certain patients to determine if any screened patient was depressed. We included all adult patients who visited Tuality Health Care primary care clinics between July 1, 2001 and September 30, 2001 in the study. We excluded patients attending the clinic for an emergency and children below 15 years of age.

RESULTS: Out of 3431 subjects initially screened, we included 3290 subjects (96%) in the analysis. Of these, 360 subjects (10.9%) were already being treated for depression. The median age of the population was 48.5, 63.6% were females, and 36.4% were males. Physicians were more likely to conduct further assessment for depression when the screening result was positive (odds ratio [OR] = 119.13, 95% confidence interval [CI]: 81.017-175.17). They were also more likely to make a new diagnosis of depression when the screening result was positive (OR = 117.245, 95% CI: 51.67-266.02).

CONCLUSION: The intervention is a useful depression screening effort in primary care. We should also consider implementation in other primary care settings.