According to the World Health Organization as of March 2023, “An estimated 3.8% of the population experience depression, including 5% of adults (4% among men and 6% among women), and 5.7% of adults older than 60 years. Approximately 280 million people in the world have depression (1). Depression is about 50% more common among women than among men.” Additionally, Maurer et al. (2018) report, “Depression affects an estimated 8% of persons in the United States and accounts for more than $210 billion in health care costs annually. The U.S. Preventive Services Task Force (USPSTF) and American Academy of Family Physicians recommend screening for depression in the general adult population.” Kroenke et al. (2001) report that the Patient Health Questionnaire is a 3-page questionnaire used for the assessment of depressive disorders; the PHQ-9 is described as a “9-item depression module from the full PHQ.” The PHQ-9 is a widely validated tool that can be used in a two-stage screening process (Costantini et al., 2021). The PHQ-2 – a two-item screening tool – can be used during an initial interview. In the event of a positive result from the PHQ-2, it is recommended that it be followed up by the PHQ-9 for a more comprehensive evaluation (Maurer et al., 2018). The US Preventive Services Task Force recommends screening the general population for depression (Siu et al., 2016). Further, the Task Force recommends that adolescents aged 12-18 be screened depression in the primary care setting (as cited in Maurer et al., 2018). Additionally, “pregnant women should be screened for depression at least once during the perinatal period using a validated screening instrument” (Maurer et al., 2018). In the case of older adults, the Cornell Scale for Depression in Dementia, or Geriatric Depression Scale can be used in addition to the PHQ-2 and PHQ-9 (Tsoi et al., 2017). Depression screening in the primary care setting can be a pivotal first step in connecting patients and clients with appropriate services to address depressive symptoms. At Asian Counseling and Referral Service, an outpatient mental health provider, we work with individuals reporting depressive symptoms frequently. We often receive referrals from primary care providers for clients reporting depressive symptoms. In my work as an intake clinician, I attempt to paint a picture of the client’s life and background to gain an understanding of their presenting concerns. I use Socratic questioning to enquire about the client’s family background, schooling and employment, hobbies, social groups, gender identity and sexual orientation, and cultural influences. Thereafter, I ask the client to describe the circumstances that prompted them to seek mental health services. I rely on both these interview techniques and on screening and diagnostic tools such as the PHQ-9 and the GAD-7 (used for assessing Generalized Anxiety Disorder) create a clinical formulation. Thereafter, based on the severity of the client’s depressive and anxious symptoms, as well as the stressors identified by the client, we develop a comprehensive, individualized treatment plan to address the client's presenting concerns, which can involve a combination of culturally sensitive talk therapy and psychopharmacology. In conclusion, considering the prevalence of depression in the general population, it is important that we, as healthcare professionals, prioritize the implementation of screening measures that allow for early intervention for these clients. References Costantini, L., Pasquarella, C., Odone, A., Colucci, M. E., Costanza, A., Serafini, G., ... & Amerio, A. (2021). Screening for depression in primary care with Patient Health Questionnaire-9 (PHQ-9): A systematic review. Journal of affective disorders, 279, 473- 483. Kroenke, K., Spitzer, R. L., & Williams, J. B. (2001). The PHQ‐9: validity of a brief depression severity measure. Journal of general internal medicine, 16(9), 606-613. Maurer, D. M., Raymond, T. J., & Davis, B. N. (2018). Depression: screening and diagnosis. American family physician, 98(8), 508- 515. Nease, D. E., & Malouin, J. M. (2003). Depression screening: a practical strategy. Journal of Family Practice, 52(2), 118-126.[AM1] O’Connor, E., Rossom, R. C., Henninger, M., Groom, H. C., & Burda, B. U. (2016). Primary care screening for and treatment of depression in pregnant and postpartum women: evidence report and systematic review for the US Preventive Services Task Force. Jama, 315(4), 388-406. Siu, A. L., Bibbins-Domingo, K., Grossman, D. C., Baumann, L. C., Davidson, K. W., Ebell, M., ... & US Preventive Services Task Force. (2016). Screening for depression in adults: US Preventive Services Task Force recommendation statement. Jama, 315(4), 380-387. Tsoi, K. K., Chan, J. Y., Hirai, H. W., & Wong, S. Y. (2017). Comparison of diagnostic performance of Two-Question Screen and 15 depression screening instruments for older adults: systematic review and meta-analysis. The British Journal of Psychiatry, 210(4), 255-260. US Preventive Services Task Force. Preventive Services Task Force: Final Recommendation Statement. (2016). NWRPCA welcomes and regularly publishes white papers and articles submitted by members, partners and associates with subject matter expertise. The appearance of any guest publication in our Health Center News database represents the views of the author and does not constitute endorsement by NWRPCA of the stated opinions or perspectives, nor does it suggest endorsement of the contributor's products or services.
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This project is supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) as part of an award totaling $1,742,242.00 with 25% financed with nongovernmental sources. The contents are those of the author(s) and do not necessarily represent the official views of, nor an endorsement, by HRSA, HHS or the U.S. Government.