Survey-based vs. Chart-based Screening Yields Significantly Higher Rates of Depression among Veterans in Primary Care
BACKGROUND:
More efficient procedures for screening and diagnosing depression, as well as the advent of better-tolerated antidepressants have increased primary care (PC) providers’ ability to manage mild to moderate depression. Nonetheless, despite U.S. Preventive Task Force recommendations for practice-based screening of all PC patients, just 21% report being screened. Yearly depression screening by PC staff is mandated in VA, yet little is known about the expected yield from such screening when administered on a practice-wide basis. This study sought to characterize the yield of practice-based screening in 10 diverse VA primary care clinics (rural and urban), as well as the care needs of Veterans assessed as having depression. Investigators surveyed 10,929 Veterans enrolled in a randomized controlled trial evaluating implementation of collaborative care for depression from 2002-2004. In addtion to depression screening, investigators examined demographics, medical comorbidity, and mental health comorbidities (e.g., PTSD, anxiety disorder, and alcohol abuse).
FINDINGS:
- 95% of respondents were male with a mean age of 67 years.
- Practice-wide survey-based depression screening yielded more than twice the positive-screen rate demonstrated through chart-based VA performance measures.
- Practice-wide depression screening yielded 20% positive depression screens and 12% probable major depression. This is substantially higher than most previously reported VA rates. For example, VA performance measures, which rely on chart reviews of random samples of clinic visitors to determine annual screening yields, reflected 9% positive screens in the same year this study’s enrollment began.
- Comorbid mental illness was highly prevalent. Two-thirds of Veterans with depression reported comorbid PTSD or symptoms of generalized anxiety or panic disorders, while a significant proportion reported consuming a minimum of 6 drinks occasionally or daily. In addition, nearly one-third of Veterans with depression reported recent suicidal ideation.
- Comorbid medical illness also was substantial. More than one-third of Veterans with depression reported histories of chronic lung disease, pneumonia, and diabetes. In addition, 80% of depressed Veterans reported their general health as fair or poor.
LIMITATIONS:
- Findings were based on telephone-based patient self-report rather than chart review.
- Data are from 2002-2004. Depression care within VA has evolved significantly in subsequent years, in part as a result of the main trial’s findings.
AUTHOR/FUNDING INFORMATION:
This study was funded through VA/HSR&D’s Quality Enhancement Research Initiative (QUERI: MHI 99-375, MNT 01-027). Dr. Yano also was supported by an HSR&D Research Career Scientist Award and is part of Mental Heath QUERI and HSR&D’s Center for the Study of Healthcare Provider Behavior, Sepulveda, CA. Dr. Chaney is part of HSR&D’s Northwest Center for Outcomes Research, Seattle, WA.
Yano EM, Chaney EF, Campbell D, et al. Yield of Practice-Based Depression Screening in VA Primary Care Settings. Journal of General Internal Medicine October 6, 2011;E-pub ahead of print.
