Health Services Research & Development

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2007 HSR&D National Meeting Abstract

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National Meeting 2007

3044 — Depression Screening is Inadequate in Veterans with Cancer

Jones LE (HSR&D Center for Implementing Evidence-Based Practice (CIEBP), Roudebush VAMC, Indianapolis) , Carney Doebbeling C (Department of Medicine, Indiana University; Regenstrief Institute; Indianapolis)

Objectives:
The VA mandates annual depression screens in primary care. Nationally, 95% of all veterans are screened on an annual basis. Depression is highly prevalent (35-50%) in cancer patients, highlighting the importance of routine depression screening. The objective of this study was to assess depression screening rates and outcomes in veterans with cancer.

Methods:
Linked clinical, administrative, and pharmacy data (2000-2004) from a Midwestern VA facility were analyzed. Patient eligibility was based on VA External Peer Review Program inclusion/exclusion criteria. Subjects with cancer (excluding non-melanoma skin cancer) were eligible if they received VA healthcare services in the 1- and 2-year period prior to the cancer diagnosis and were not already in treatment for depression. Dichotomous outcomes were assessed: proportion screened for depression, results of screening exam (positive/negative), referral rates to mental health, and rates of depression diagnosis and treatment after screening. Demographic and clinical characteristics influencing screening were evaluated using multivariate regression.

Results:
1,967 subjects were eligible for depression screening; 65% were screened. Screening rates improved from 40% in 2000 to 76% in 2003 (test for trend: p<0.0001) and were highest among subjects with prostate cancer (78%). 17% of subjects screened positive, with the highest rates in patients with leukemia (23%). Few subjects (11%) who screened positive were referred to mental health clinics after screening positive. Depression treatment rates were higher among subjects screening positive who were versus were not referred to mental health (57% vs. 26%, p<0.0001). 73% of subjects who screened positive and were referred to mental health were diagnosed with depression. Demographic and clinical characteristics were not associated with screening in multivariable modelling.

Implications:
Depression screening rates are substantially lower in cancer patients as compared to national VA rates. 25% of cancer patients fail to receive screening. Patients referred to mental health are significantly more likely to be treated for depression.

Impacts:
Given the high rates of depression in cancer patients, routine depression screening is necessary to identify patients with psychosocial distress. Non-recognition of depression may influence survivorship and prognosis. Future research should address how to more effectively screen and treat depression in the oncology setting.