depression, primary care physician, mental health, pcp

Primary care doctors on the front lines of depression screening

Dec 21 2016

If you go to your primary care physician (PCP) after experiencing joint pain or back pain, don’t be surprised if you’re asked a series of questions about how much energy you have, your appetite and self-opinion. These questions are a part of the “Patient Health Questionnaire” and are used by physicians to take a proactive approach to screening for depression.

“Family medicine physicians, internists, OB/GYN physicians, nurse practitioners and physician assistants are the frontline of adult primary care, ” said John Moore, DO, FAAFP, Aetna’s medical director for the United States’ Northeast Region. “These primary care providers conduct a great deal of mental health screening in a manner that is direct, as well as indirect, since the PCP can indirectly perform a depression screening while examining the patient for something different. Patients come to us with complaints, but we are assessing them for everything.”

Over 350 million people in the world suffer from depression

The questionnaire can be filled out by the patient or a PCP may ask the questions during an evaluation. It can help a physician assess the patient’s state, and if they are depressed, how best to help.

Depression: what is it and what are the symptoms?

Across the world, more than 350 million people of all ages suffer from depression, according to the World Health Organization. More than 5 percent of people in the U.S., who are 12 years old or older, reported having depression, according to 2009 to 2012 data by the U.S. Centers for Disease Control and Prevention. Common symptoms include feelings of sadness, hopelessness, or depressed mood; loss of interest or pleasure in activities that used to be enjoyable; and a change in weight or appetite.

Depression can also cause physical symptoms, according to research published in The Journal of Clinical Psychiatry, including chronic joint pain, limb pain, tiredness, and back pain, are often presenting symptoms of depression.

Physical symptoms can be presenting signs of depression

Experiencing these physical symptoms can lead a person to make an appointment with their PCP, who may diagnose them with depression, according to Gabriela Cora, M.D., DFAPA, a medical director for Aetna Behavioral Health.

“Many people who get diagnosed with depression at the PCP-level are not going in for depression symptoms, but they’re going in for something else,” Cora said. “The PCP will look at charts and symptoms, frequency of doctor visits and whether the person’s symptoms are getting better or if they’re really depressed.”

The U.S. Preventative Task Force recommends adults over the age of 18 are screened for depression. Common tests include the “Patient Health Questionnaire,” the “Hospital Anxiety and Depression Scales” in adults, the “Geriatric Depression Scale” in older adults and the “Edinburgh Postnatal Depression Scale” in postpartum and pregnant women.

“Some people may be waiting in their waiting room and are asked to fill out a form to see if there is a sign or symptom of depression,” she said. “There are different ways in which physicians may screen a patient.”

What can you do?

Denial and stigma can prevent a person from accepting they may be depressed, Cora said. She emphasized that acceptance is often the first barrier.

Depression can also affect how a person recovers from various conditions and diseases. People who are depressed recuperate less quickly, Cora said. Being in a healthy mental state, she added, is much better for the body.

“If they can get over the first barrier and acknowledge, ‘Maybe I’m not doing so well,’ they can get the treatment they need to feel better,” Cora said.