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Depression Screening and the Community

Roughly 40 million adults in the U.S. struggle with depression or anxiety. Not to mention the family, friends, and coworkers that are also impacted. Depression affects individuals of all ages, races, social classes, professions and genders. There are five types of depression: Major depressive disorder, persistent depressive disorder, adjustment disorder with depressed mood, seasonal affective disorder, and postpartum depression. Major depressive disorder is the most common type of depression and affects more than 15 million adults in the United States and is the leading cause of disability in the U.S. for individuals 15-44 years of age. The following signs and symptoms characterize depression:

  • Sleep disturbance
  • Loss of interest in activities
  • Feelings of guilt
  • Loss of energy
  • Difficulty concentrating
  • Change in appetite
  • Psychomotor agitation
  • Sadness
  • Suicide ideations

How workplaces can get involved in depression screening

Depression is one of the most common health issues affecting the workplace. Untreated depression costs employers over $51 billion due to absenteeism and decreased productivity, according to a 2003 study published in the Journal of Clinical Psychiatry. During a three-month period, people with depression miss an average of 4.8 workdays and suffer 11.5 days of reduced productivity. Employers can recommend every employee go to HelpYourselfHelpOthers.org and complete an anonymous depression-screening questionnaire. Employees who exhibit potential signs of depression will be given information about local resources that provide help.

 

How schools can get involved

Depression among children and adolescents is common but frequently unrecognized. It affects 2 percent of prepubertal children and 5 to 8 percent of adolescents. More specifically, the prevalence of major depressive disorder in the United States is approximately 1 percent of preschoolers, 2 percent of school-aged children and 5 to 8 percent of adolescents. Depression in children often presents with stomach pains, headaches and not wanting to go to school in addition to the signs and symptoms that commonly present in adults. The National Association of Mental Illness (NAMI) strongly supports screening for depression and other mental health disorders early on in both school settings and in the pediatrician’s office. NAMI believes that it is important for teachers and school counselors to be able to educate themselves on the warning signs of depression (and other mental health disorders) so treatment and intervention can take place early on.

Screening for depression on college campuses

39% of college students reported experiencing anxiety and depression in the past year and there has been a 30% increase in the number of college students seeking mental health services between 2009 and 2015. Many college campuses are now offering free screening for depression through either student health, mental health fairs, or through mental health support groups on campus. Additionally, college students have a plethora of online resources where they can screen themselves for depression and then seek help from a professional.

 

Screening for depression at the doctor’s office

It is recommended that primary care physicians screen their patients of all ages for depression however many physicians do not. In 2002, the US Preventive Services Task Force endorsed screening for depression in primary care settings, particularly when screening is coupled with system changes that help ensure adequate treatment and follow-up. The focus on screening for depression in primary care makes sense since almost two-thirds of patients with depression receive care in that setting. Despite the frequency of depression, diagnosis by nonspecialist practitioners is often haphazard. Studies show that primary care physicians who provide usual care fail to recognize depressive symptoms in 30% to 50% of patients with depression. What is being missed is not a small problem here and there, but a range of disorders, some of which, such as major depression, occur frequently and can be quite severe. For example, of persons who committed suicide, 40% had visited their primary care physician in the month before their death. As a result of these numbers, it is important for patients to find doctors who talk about mental health and screen for depression on a regular basis. Additionally, it is also important for patients to educate themselves on the signs and symptoms associated with depression. Below is a list of depression screening tools that are done in a primary care physician’s office from most common to least common.

  • Hamilton Depression Rating Scale (HDRS)
  • Beck Depression Inventory (BDI)
  • Patient Health Questionnaire (PHQ)
  • Major Depression Inventory (MDI)
  • Center for Epidemiologic Studies Depression Scale (CES-D)
  • Zung Self-Rating Depression Scale (SDS)
  • Geriatric Depression Scale (GDS)
  • Cornell Scale for Depression in Dementia (CSDD)

 

Kristen Fuller, M.D., is a clinical content writer and enjoys writing about evidence-based topics in the cutting-edge world of mental health and addiction medicine. She is a family medicine physician and author, who also teaches and contributes to medicine board education. Her passion lies within educating the public on preventable diseases including mental health disorders and the stigma associated with them. She is also an outdoor activist and spends most of her free time empowering other women to get outside into the backcountry.

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