BACKGROUND AND PURPOSE:

• Systematic depression screening has been broadly adopted in the US primary care setting
• Garcia et al. (JAMA Intern Med, 2024) investigated factors associated with initial treatment among patients who screen positive for depression and/or suicidal ideation (SI)

METHODS:

• Retrospective cohort study
  • UCSF Health System
  • Depression screening implemented in September 2017 | 89% screening rate achieved
• Population
  • Adult primary care patients with elevated depressive symptoms (Patient Health Questionnaire [PHQ]-9 score ≥10) and/or SI
  • Exclusion: Patients with baseline depression or other psychiatric conditions
• Exposures
  • Patient characteristics
    • Age | Gender | Preferred language | Race/ethnicity
• Study design
  • Multivariable logistic regression models were used to estimate probability of treatment
  • Adjustments: Site and clustering by primary care physician
• Primary outcome
  • Antidepressant or mental health referral ordered at screening
• Secondary outcomes
  • Antidepressant or mental health referral ordered within 8 weeks
  • Antidepressant or follow-up visit specifically for depressive symptoms within 8 weeks

RESULTS:

• 60,062 patients screened
• Patients reporting elevated depression symptoms or SI: 7%
  • Mean age: 46.5 (SD, 17.6) years | Women: 68.1%
  • Black: 12.4% | American Indian/Alaska Native: 0.8% | Asian: 24.8% | Latino/a/x: 14.6% | Pacific Islander: 1.5% | White: 36.9% | Other: 9.0%
  • Preferred non-English language: 5.6%
  • Screening via patient portal: 15.5%
• Received antidepressants/referral at screening: 38%
  • Rate for just patients with SI: 44%
• Received antidepressants/referral by 8 weeks: 70%
  • Rate for just patients with SI: 75%
• Patients who were screened through the patient portal had significantly lower odds of receiving treatment
  • Patient portal screening: 13.4%
  • Visit screening: 42.7%
  • Adjusted odds ratio (aOR) 0.20 (95% CI, 0.14 to 0.27)
• There were no statistically significant differences in the primary outcome by
  • Gender
  • Preferred language
  • Health insurance
• Compared to White patients, both Black and Asian patients had lower estimated probabilities of treatment being ordered at screening
  • Black patients: 34.0% (95% CI, 28.4 to 39.6)
  • Asian patients: 35.4% (95% CI, 31.5 to 39.4)
  • White patients: 40.5% (95% CI, 37.4 to 43.5)
• Estimated probability of treatment decreased with increasing age
  • Patients aged 18 to 30 years: 46.4% (95% CI, 41.2 to 51.5)
  • Patients aged ≥75 years: 17.5% (95% CI, 12.1 to 22.9)
• Despite treatment being overall low, patients with SI had greater estimated treatment than those without SI
  • With SI: 43.5% (95% CI, 39.9 to 47.1)
  • Without SI: 35.2% (95% CI, 33.0 to 37.5)
• Secondary outcomes
  • There were no significant differences in follow-up visits for Black and Asian patients, compared to White patients

CONCLUSION:

• Treatment rates after depression screening in primary care are moderate
  • Overall, at screening: 38%
  • Overall, within 8 weeks of screening: 70%
• However, some patient characteristics were associated with lower probability of treatment
  • Black or Asian race
  • Older age
• Treatment rates for individuals with SI are overall low for such a high-risk group
• The authors state

…health systems should track treatment rates and develop approaches to ensure equitable patient-centered treatment and follow-up for all patients, specifically for groups at risk of undertreatment, including African American or Black and Asian patients, older adults, and those screened via the patient portal

Learn More – Primary Sources:

Depression Treatment After a Positive Depression Screen Result