Depression is the most common mood disorder in the general population. In 2014, an estimated 15.7 million adults aged 18 or older in the U.S. had at least one major depressive episode in the past year. This number represented 6.7% of all U.S. adults. In 2014, an estimated 11.4% of adolescents aged 12 to 17 in the U.S. had at least one major depressive episode in the past year. Prevalence of antenatal depression can be as high as 20%, while approximately 12% to 16% of women experience postpartum depression.
Although depression is common in the primary care setting, accurate identification of these patients is challenging. This is a brief overview of the most common, accurate and most time efficient screening tools that address depression in adults, adolescents and perinatal women. Links to each of the tools is provided at the end of the article.
ADULTS: Depression has been associated with poorer outcomes in patients with a variety of medical conditions, such as coronary artery disease, diabetes mellitus, and stroke. Treatment of depression may reduce mortality from these conditions, as well as help prevent suicide. Therefore, accurately identifying patients who have depression is important so that appropriate treatment can be initiated.
The most widely used and best-validated instruments in primary care are the PHQ-9 and its two-item version, the PHQ-2. The PHQ-2 is similar in accuracy to the PHQ-9, but does not allow for the evaluation of severity or impact on daily activities.
ADOLESCENTS: The USPSTF recommends screening for major depressive disorder (MDD) in adolescents aged 12 to 18 years. The current evidence is insufficient to assess the balance of benefits and harms of screening for MDD in children aged 11 years or younger. No specific criteria for frequency of screening has been established at this time.
Two tools that have been most often studied are the Patient Health Questionnaire for Adolescents (PHQ-A) and the primary care version of the Beck Depression Inventory. The PHQ-A is more time efficient.
Treatment options for MDD in children and adolescents include pharmacotherapy, psychotherapy, collaborative care, psychosocial support interventions, and complementary and alternative medicine approaches.
PERINATAL WOMEN: Perinatal depression is one of the most common complications of pregnancy, affecting one in seven women. It includes minor and major depressive episodes occurring during pregnancy or the first 12 months after delivery. It often goes unrecognized because changes in sleep, appetite, and libido may be attributed to normal pregnancy and postpartum changes. The American College of Obstetricians and Gynecologists (ACOG) has released recommendations on screening women for perinatal depression at least once, with the purpose of increasing awareness of depression and lessening the effects it has on pregnant and postpartum women and their families. Pediatricians can capitalize on their relationships with families to help identify women with maternal depression.
The Edinburgh Postnatal Depression Scale and PHQ-9 are the two most commonly recommended. Women with current depression or anxiety, a history of perinatal mood disorders, or risk factors for perinatal mood disorders warrant particularly close monitoring, evaluation, and assessment.
Although screening is important first step for detecting depression, screening by itself is insufficient to improve clinical outcomes and must be coupled with appropriate follow-up and treatment when indicated. All positive screening results should lead to additional assessment that considers severity of depression and comorbid psychological problems (eg, anxiety, panic attacks, or substance abuse), alternate diagnoses, and medical conditions.
Staff at SmartCare are available to consult and assist with referring patients to the appropriate behavioral health resources, when indicated.
PHQ-A (Teens): https://www.aacap.org/App_Themes/AACAP/docs/member_resources/toolbox_for_clinical_practice_and_outcomes/symptoms/GLAD-PC_PHQ-9.pdf
Edinburgh Postnatal Depression Scale: http://www.aafp.org/afp/2010/1015/p926.html