In recent years, in response to declining stigma and increasing awareness about mental health issues, it’s become more common to receive a depression screen in a primary care setting, which begs the question:
What happens after I get a depression screen at my regular doctor?
Here’s what should happen:
- You get a result, which either confirms the presence of a depressive disorder, or rules it out. The outcome determines what happens next.
- If the screening confirms clinical depression, officially called major depressive disorder (MDD), your primary care provider will give you a referral for specialist care, a prescription for anti-depressant medication, or both.
- You follow directions. If you receive a referral for specialist care or further assessment, follow up, make an appointment, and follow their directions, which should include either a treatment plan, or a referral to an appropriate provider.
That’s what should happen – but is that what actually happens?
An article published recently in the Journal of the American Medical Association (JAMA) called “Depression Treatment After a Positive Depression Screen Result” examined records collected on the outcomes of depression screening administered between 2017 and 2021 in order to answer that exact question.
We’ll discuss the results of that study below.
First, though, we’ll reiterate something we think is important.
Depression Screen and Diagnosis: Your Options
If you receive a depression screen, a diagnosis, a referral, and a treatment plan, the most important thing you can do is follow your treatment plan. When it involves medication, ask every question you can think of about the medication. Be sure to address any concerns or hesitation you might have. When your plan involves psychotherapy, do the same. Ask any and all questions you may have. Address any concerns or hesitations you might have.
Do all that before you commit to a treatment plan.
In addition, a typical treatment plan for depression often includes lifestyle changes, family involvement, and social support. If your provider includes lifestyle changes as part of your treatment plan, make sure you implement those too. While they’re not the core of your treatment, most suggested lifestyle changes – getting good sleep, eating good food, and getting plenty of exercise/activity – are the foundation of a healthy lifestyle, overall. It’s a good choice to make those changes, because good overall health is the foundation of healing and growth.
With all that said, let’s take a look at the results of that study on what happens after a depression screen administered in a primary care setting.
What Happens After a Depression Screen?
We should also not that in this study, researchers asked patients if they engaged in suicidal ideation (SI), which means having any thoughts of suicide.
The outcomes the researchers examined included: 1. Referral for antidepressant medication or mental health treatment ordered at screening, and 2. Referral for antidepressant medication or mental health treatment within 8 weeks or referral for antidepressant/referral mental health treatment and/or follow-up within 8 weeks of initial screening.
Here’s what they found at the initial assessment of 60,062 patients analyzed in the study:
- 7% of patients reported symptoms of depression or suicidal ideation
Among those:
- Suicidal ideation: 44% received antidepressants and/or referral for mental health treatment
- Depressive symptoms: 38% received antidepressants and/or referral for mental health treatment
Here’s the demographic breakdown of those patients:
- Gender:
- Female: 68.1%
- Ethnicity:
- White: 36.9% / Asian: 24.8% / Latino/Latina/Latinx: 14.6% / Black: 12.4% / Pacific Islander: 1.5% / American Indian or Alaska Native: 0.8% / Other: 9.0%
- Mean Age: 46.5
And here’s what they found at the 8-week follow-up:
- Suicidal ideation: 75% received a referral for antidepressants/referral for mental health treatment and/or engage in a follow-up visit within 8 weeks of initial screening
- Depressive symptoms: 70% received a referral for antidepressants/referral for mental health treatment and/or engage in a follow-up visit within 8 weeks of initial screening
The research team indicated no significant differences in outcome by gender, but noted differences by race/ethnicity:
- Black patients: 34% received referrals for treatment
- Asian patients: 35% received referrals for treatment
- White patients: 41% received referrals for treatment
They also indicated that rates of treatment decreased as age increased:
- Treatment among 18–30-year-olds: 46.4%
- Treatment among patients 75 and older: 17.5%
Finally, the research team found that patients with SI had greater rates of treatment than those without SI:
- Depressive symptoms with SI: 43.5% received referrals for treatment
- Depressive symptoms without SI: 35.2% received referrals for treatment
However, rates of treatment were low for this group. When we consider the fact that the presence of suicidal ideation among people with depression increases risks of adverse outcomes, this treatment gap is of significant concern.
How This Study Helps Us Help Our Patients
Let’s back up and consider the overall results from this study, but we’ll report them from another point of view:
Depressive symptoms + suicidal ideation:
56% didn’t receive antidepressant medication or a referral for mental health treatment.
Over half of the patients who reported depressive symptoms and suicidal ideation didn’t receive medication or a referral for psychotherapy. It’s important to note that this appears as if neither the physician nor the patient took any action, but we don’t know that for certain. However, we do know that one, the other, or both are the common standard of care.
The fact that over half appeared to have received no instruction and/or took no action is a problem.
Now let’s look at the overall result for patients who reported depressive symptoms alone:
62% didn’t receive antidepressant medication or a referral for mental health treatment.
That means nearly two out of every three patients who reported depressive symptoms did not receive the standard first-line medication for depression, antidepressants, or the standard first-line behavioral treatment for depression, psychotherapy.
That’s also a problem.
And that’s where we can help. We’re connected to an extensive group of primary care providers in our area. We have access to literally thousands of others and stay in regular contact with this wide and diverse referral network.
What we take away from this new information is that we can increase our efforts to share the best practices for the next steps to take after a positive screen for depression. We can also reiterate the fact that the presence pf depressive symptoms and suicidal ideation at the same time increases the chance of a negative outcome, especially when untreated.
When we’re sure everyone has all the information they need, we’re confident they’ll make the best decision. That means referring patients to care when they need it. The sooner a person with a mental health disorder gets appropriate, diagnosis-matched, evidence-based care, the better their chances at achieving sustained, long-term recovery.
