A student post this about depression, please reply and include 1 reference. Primary care physicians treat more than 50% of patients with mental disorders, and depressive disorders are accurately diagnosed in less than half of the patients who are affected (Indu et al, 2017). A patient’s culture, gender, and/or predominance of somatic symptoms can impede the detection of depression. This is reflected by biases found in self-reporting screening tools used to detect depression. Depression is projected to be a leading cause of global burden of disease by 2030 (Indu et al 2017). It also increases the risk for suicide and non-communicable diseases such as ischemic heart disease. Its prevalence is 13.2% among women attending general practice clinics and 23% among obese people (Indu et al, 2017). In India, depression is the most common psychiatric disorder reported in community settings. Community prevalence of depression in India is 15.9%, whereas in primary care, it ranges from 21 to 84% (Indu et al, 2017). An increase in depression prevalence has been reported over the past few decades. If identified and treatment initiated, outcome in depression is good, and at 1-year follow-up, 71% of patients with depression demonstrated no symptoms or social impairment (Indu et al, 2017). If left untreated, it aggravates co-existing physical illness and results in more frequent consultations. Early identification and management would reduce the disability and the risk of suicide. From an economic perspective, the overall healthcare cost can be reduced, if depression is identified early and treated. But, unless specifically screened, depression remains underrecognized and untreated in the primary care setting (Indu et al, 2017). Hence, depression screening is an important part of primary care. Depression affects an estimated 8% of persons in the United States and accounts for more than $210 billion in health care costs annually. The . Preventive Services Task Force (USPSTF) and American Academy of Family Physicians recommend screening for depression in the general adult population (Maurer et al, 2018). Additionally, the USPSTF recommends screening children and adolescents 12 to 18 years of age for major depressive disorder (Maurer et al, 2018). All screening should be implemented with adequate systems in place to ensure accurate diagnosis, effective treatment, and appropriate follow-up (Maurer et al, 2018). The two-item and nine-item Patient Health Questionnaires (PHQs) are commonly used validated screening tools. The PHQ-2 has sensitivity comparable with the PHQ-9 in most populations; however, the specificity of the PHQ-9 ranges from 91% to 94%, compared with 78% to 92% for the PHQ-2 (Maurer et al, 2018). If the PHQ-2 is positive for depression, the PHQ-9 or a clinical interview should be administered. Screening all postpartum women for depression is recommended by the USPSTF, American Academy of Family Physicians, American Academy of Pediatrics, and American College of Obstetricians and Gynecologists. Women should be screened for depression at least once during the perinatal period using the PHQ-2, PHQ-9, or Edinburgh Postnatal Depression Scale (Maurer et al, 2018). In older adults, the Geriatric Depression Scale is also an appropriate screening tool for depression. If screening is positive for possible depression, the diagnosis should be confirmed using Diagnostic and Statistical Manual of Mental Disorders (Maurer et al, 2018). Primary care providers must begin to realize that they will always struggle to achieve the level of care they desire for all of their patients with depression in the current environment. Models of health care delivery have been developed and tested that do improve outcomes for patients with depression (Ford, 2018). Depression care teams with expertise in mental health and primary care, active follow-up of patients, and more visits than usual for primary care are the hallmarks of successful programs (Ford, 2018). Primary care providers have the obligation to learn about these programs and advocate for more widespread implementation. While these programs will not guarantee that all patients with depression will have resolution of their symptoms, they can be the foundation to learn more about why many patients do not receive guideline-concordant care or respond to treatment (Ford, 2018). If primary care providers are going to have a substantial role in any organized system of care for patients with depression, a set of skills that all primary care providers possess needs to be defined (Ford, 2018). Primary care providers who believe it is acceptable to take a very limited or no role in the care of patients with depression compromise efforts to build systems of care that clarify for both patients and physicians who is responsible for recognition, acute care, and continuing care of individuals with depression.Show more
