Home | Business News | Browse by Publication | J | Journal of Family Practice

Screening adults for depression in primary care: a position statement of the American College of Preventive Medicine.

Article Excerpt
Position statement

The American College of Preventive Medicine (ACPM) maintains that primary care providers should screen all adults for depression and that all primary care providers should have systems in place, either within the primary care setting itself or through collaborations with mental health professionals, to ensure the accurate diagnosis and treatment of this condition. The earliest and best opportunities to identify depression are in the clinics of primary care providers. Thus, the ACPM supports the recommendations of the US Preventive Services Task Force (USPSTF), and further suggests that all primary care practices should have such systems of care in place.

Why a position statement? The rationale

Primary care physicians have already been urged by the USPSTF and other authorities to consider screening adults for depression an essential aspect of care. (1-5) So why is the ACPM issuing a new position statement on the subject? Because, the College believes, controversy over how to apply this mandate in the primary care setting is ongoing. Primary care providers--whether they practice family medicine, internal medicine, obstetrics/gynecology, or are in general practice--need to know what role they should play in screening adults for depression and ensuring adequate diagnosis and treatment.

The USPSTF recommendation

In May 2002, the USPSTF made a category B recommendation (high certainty of moderate net benefit) that adults should be screened for depression in "clinical practices that have systems in place to assure accurate diagnosis, effective treatment, and follow-up" of depression (1) (emphasis added). The less-than-clear aspect of this recommendation is italicized: Just what constitutes the "system" that primary care providers, the first and often the only point of contact adults have with the health care system, are told to have "in place"? And how can they go about providing such systems? That's what the College has set out to elucidate.

The toll depression takes

Depression is a potentially life-threatening disorder that affects up to 6.7% of the population 18 years of age and older, or approximately 14.8 million Americans, in a given year. (6) Many people younger than age 18 are also affected. The extensive STAR*D (Sequenced Treatment Alternatives to Relieve Depression) study of outpatients with depression found that nearly 40% of respondents had their first depressive episode before the age of 18. (7,8)

The ripple effects

Depression is the leading cause of disability in the United States for individuals between the ages of 15 and 44 years. (9) But the burden of this illness is not...