Depression Screening Improves Detection and Outcomes

Depression is a common mental health condition that often remains undetected. Untreated depression affects both quality of life and physical health. The U.S. Preventive Services Task Force (USPSTF) recommends screening for depression in all adolescents aged 12 to 18 years and in all adults over the age of 18. Screening improves the detection of depression, which leads to earlier treatment and better outcomes. Routine screening also reduces gaps in depression care.

The most used depression screening instrument is the Patient Health Questionnaire (PHQ^®) in various forms. Screening often begins with a short screening test, such as the first two questions of the PHQ-9^®, followed by the full PHQ-9^® if there are any positive responses.

When choosing a depression screening tool, it’s important to consider the ease of screening administration and suitability for the patient. Other screening tools to consider include:

• Center for Epidemiologic Studies Depression Scale (CESD)
• Geriatric Depression Scale (GDS)
• Beck Depression Inventory (BDI^®)
• Patient-Reported Outcomes Measurement Information System (PROMIS) Depression Scale
• Duke Anxiety-Depression Scale (DUKE-AD^®)
• My Mood Monitor (M-3^®)
• Clinically Useful Depression Outcome Scale (CUDOS)
• Edinburgh Postnatal Depression Scale (EPDS)

No matter which tool is used, all positive screening results should lead to additional evaluation and follow up to confirm a clinical diagnosis. Best practices for depression screening and follow-up include:

• Screen for depression at routine health visits, starting with a two-question screen at patient check-in.
• Administer a full depression screening tool if there are any positive responses on the two-question screen.
• Schedule a follow-up appointment before the patient leaves the office if a full depression screening tool is positive. This ensures care is received within 30 days of initial positive screening.
• Use a registry to track positive screening scores and ensure follow-up.

To ensure accurate reporting on clinical quality measures, it’s important to use the appropriate codes for both the screening tool and result, and partner with your health plan payers to submit electronic data from your EMR extract. Refer to the Depression Screening and Follow-Up for Adolescents and Adults HEDIS^® tip sheet for more on this measure.