• Printer-friendly Mental Clinical Measure 12a: Depression Screening Detail Sheet (Acrobat/pdf)

All users >18 years old with at least one encounter during the year.

• Exclude only those users whose only encounter(s) during the year was CPT code 99211 or 99212 (established patient with encounter <10 minutes).

• An appropriate benchmark is not available for external comparison at this time.
• Grantee should be showing improving internal trend over time.
• Healthy People 2010 #18-6 (Developmental) calls for an increase in the number of persons seen in primary health care who receive mental health screening & assessment; see: http://www.healthypeople.gov/Document/HTML/Volume2/18Mental.htm
• While no established benchmark for a comparable group has been identified, the Veterans Health Administration (VHA) established a standard for rates of screening for depression in primary care with a goal of >87%. (Veterans Health Administration Office of Quality and Performance: FY2002 VHA Performance Measurement System: Technical Manual. Washington, DC, Nov 8, 2001 [updated Mar 8, 2002]). Because VHA has a more narrow definition for the primary care users sampled in monitoring its performance, VHA results may appear superior to the community health center setting where a broader definition of those who should be screened has been proposed. Also, depression may be more prevalent among VHA patients.

• Chart audit sample using the sample frame of patients meeting denominator criteria.
• Grantees participating in the BPHC Depression Health Disparities Collaborative may also be able to draw upon registry data if they use the screening tool and capture data on all adults, not just those at high risk, who meet the criteria above for the Denominator.

• The U.S. Preventive Services Task Force (USPSTF) recommends screening adults for depression in clinical practices that have systems in place to assure accurate diagnosis, effective treatment, and follow up. The USPSTF found good evidence that screening improves the accurate identification of depressed patients in primary care settings and that treatment of depressed adults identified in primary care settings decreases clinical morbidity. Trials that have directly evaluated the effect of screening on clinical outcomes have shown mixed results. Small benefits have been observed in studies that simply feed back screening results to clinicians. Larger benefits have been observed in studies in which the communication of screening results is coordinated with effective follow up and treatment. The USPSTF concluded the benefits of screening are likely to outweigh any potential harms.
  See: http://www.ahrq.gov/clinic/uspstf/uspsdepr.htm
• Research studies have shown that depression is under-detected in primary care settings. Untreated depression is associated with diminished quality of life, impaired work productivity, and decreased social functioning. Screening for depression in primary care settings has been shown to improve detection rates, but has not been shown to improve outcomes unless coupled with initiatives to improve treatment and follow-up. The general medical and primary care sector consists of health care professionals such as internists, pediatricians, and nurse practitioners in office-based practice, clinics, acute medical and surgical hospitals, and nursing homes. Close to 6 percent of the adult U.S. population use the general medical sector for mental health care, with an average of about 4 mental health visits per year—far lower than the average of 14 visits per year found in the specialty medical sector. The general medical sector has long been identified as the initial point of contact for many adults with mental disorders; for some, these providers may be their only source of mental health services. This attention to mental state in primary care can promote early detection and intervention for mental health problems.
• Major depression is “ ranked second only to ischemic heart disease in magnitude of disease burden in established market economies” and “is the leading cause of disability (measured by the number of years lived with a disabling condition) worldwide among persons age 5 and older.” Murray CJL, Lopez AD, eds. The Global Burden Of Disease And Injury Series, Volume 1: A Comprehensive Assessment Of Mortality And Disability From Diseases, Injuries, And Risk Factors In 1990 And Projected To 2020. Cambridge, MA: Published by the Harvard School of Public Health on behalf of the World Health Organization and the World Bank, Harvard University Press, 1996. (http://www.nimh.nih.gov/publicat/burden.cfm)
• For more on screening for depression, see:
  http://jama.ama-assn.org/cgi/content/full/287/9/1160
  http://www.qualityforum.org/docs/be_health/webtxbehavioralhealthreportNON-members.pdf
  http://www.aafp.org/afp/20020915/1001.html
  http://jama.ama-assn.org/cgi/content/full/289/23/3135
  http://www.jfponline.com/Pages.asp?AID=1596
  http://www.jfponline.com/Pages.asp?AID=1387
  http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=11349474
  1Validated structured screening tools for depression include:
• Patient Health Questionnaire (PHQ-9): Probably the most widely used tool in the primary care setting in the U.S, including by the BPHC Depression Collaborative(there are also validated two- and three-question versions); see: http://www.depression-primarycare.org/clinicians/toolkits/materials/forms/phq9/.
• Other validated structured depression screening tools include, but are not limited to:
  Beck Depression Inventory (BDI): http://www.uea.ac.uk/~wp316/depression.pdf
  CES-D: http://chipts.ucla.edu/assessment/Assessment_Instruments/Assessment_files_new/assess_cesd.htm
  DEPS: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=7572242
  Duke Anxiety-Depression Scale (DADS): http://healthmeasures.mc.duke.edu/
  Geriatric Depression Scale (GDS): http://www.stanford.edu/~yesavage/GDS.english.long.html
  GDS - Short Version: http://www.stanford.edu/~yesavage/GDS.english.short.score.html
  Hopkins Symptom Checklist (HSCL-25 & 90): http://www.hprt-cambridge.org/Layer3.asp?page_id=10
  Symptom Driven Diagnostic System-Primary Care (SDDS-PC): http://www.psychiatrictimes.com/p950839.html
  The Zung Self-Rating Depression Scale (SDS): http://www.wellbutrin-sr.com/hcp/depression/zung.html
  Hamilton Rating Scale for Depression: http://healthnet.umassmed.edu/mhealth/HAMD.pdf
  See also list maintained at: http://www.neurotransmitter.net/depressionscales.html

Screening alone is not sufficient.

• There must also be a system of care to assure definitive diagnosis, establishment of appropriate treatment, and follow-up care.
• One such model of care is the BPHC Depression Collaborative: http://www.healthdisparities.net/hdc/html/collaboratives.topics.depression.aspx
  & http://www.healthdisparities.net/hdc/html/library.aspx?folderId=2-24-2005.Clinical%20Resources.7842&folderOpen=yes
  & MacArthur Foundation Initiative on Depression & Primary Care: http://www.depression-primarycare.org/
• Another example is http://www.icsi.org/knowledge/detail.asp?catID=29&itemID=180