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HSR&D 2004 National Meeting Abstracts

1056. Predictors of Screening for Depression Among VA Medical Outpatients
Mayur M Desai, PhD, VA Northeast Program Evaluation Center (NEPEC) and VISN 1 MIRECC, VA Connecticut Healthcare System, RA Rosenheck, VA Northeast Program Evaluation Center (NEPEC) and VISN 1 MIRECC, VA Connecticut Healthcare System, TJ Craig, VA Office of Quality and Performance, Washington, DC

Objectives: Despite its serious health and social consequences and the availability of effective treatments, depression often goes undiagnosed and untreated. This study determines the rate and predictors of screening for depression among veterans receiving outpatient medical care.

Methods: Chart-review data from the 2000-2002 External Peer Review Program were merged with individual- and facility-level VA administrative records (N=120,570). Generalized estimating equation (GEE) logistic regression modeling was used to identify sociodemographic, clinical, service utilization, and facility characteristics associated with being screened for depression in the past year.

Results: Overall, 78.5% of eligible veterans were screened for depression. Likelihood of being screening increased with male gender (OR=1.17, p<0.001), being married (OR=1.06, p<0.01), previous diagnosis of alcohol (OR=1.14, p<0.05) or anxiety (OR=1.21, p<0.01) disorder, and number of primary care visits (OR=1.16, p<0.001), but decreased with level of service-connected disability (OR=0.88, p<0.001), previous diagnosis of drug (OR=0.69, p<0.001) or schizophrenia/psychotic (OR=0.71, p<0.001) disorder, number of specialty medical visits (OR=0.95, p<0.001), and academic emphasis (defined as percentage of funds spent on teaching and research) of the facility (OR=0.95, p<0.05).

Conclusions: Rate of depression screening is high in VA, with three-fourths of eligible patients being screened in the past year. However, veterans receiving care at VA facilities with greater academic emphasis and those with both serious mental disorders and medical conditions requiring increased specialty medical care are vulnerable to not being screened.

Impact: Greater efforts are needed to increase rate of depression screening at academically affiliated VA medical centers and among patients heavily involved in specialty care.