Mental Health Awareness Week is held every year in October to raise awareness about mental health disorders in an effort to eliminate the stigma and provide better access to treatment. National Depression Screening Day takes place October 11, 2018 and initially began as an effort to help individuals across the nation by providing them with important mental health education and connecting them with support services. Screening for Mental Health (SMH) pioneered National Depression Screening Day as the first, voluntary, mental health screening initiative in 1990. Depression is the second leading cause of mental health disorders and affects nearly 15 million adults in the United States each year and as many as one in 33 children and one in eight adolescents have clinical depression. Depression is characterized by feelings of worthlessness, changes in appetite and sleep patterns, a loss of interest in activities and hobbies, a decrease in energy, difficulty concentrating, appearing agitated or lethargic and experiencing suicidal thoughts. In order to be formally diagnosed with depression, a majority of these symptoms must be present for at least a two-week duration and must impair daily functioning. Children and the elderly are more likely to experience anger outbursts, behavioral problems and psychosomatic symptom such as aches and pains including headaches, digestion difficulties, and muscle cramps. The most common types of depression include major depressive disorder, persistent depressive disorder, adjustment disorder with depressed mood, season affective disorder, and postpartum depression. Depression can commonly co-occur with substance abuse disorders and eating disorder and is known to be more common in individuals who have chronic medical illnesses such as heart disease, cancer, HIV, diabetes and Parkinson’s disease.
Screening for depression
Many individuals who may be suffering from depression have limited access to healthcare, are in denial of their signs or symptoms or are paralyzed by the stigma associated with depression and as a result do not seek help. Primary care physicians have been trained to always screen for depression during every patient encounter. The United States Preventative Task Force (USPSTF) formally recommends that all adult patients be screened for depression using a universal questionnaire provided by health care professionals. The USPSTF labels this a category B recommendation, which means that the net benefit of this screening is moderate to substantial.
“The grade puts depression screening in the same category as yearly mammograms, diabetes screening in overweight and obese patients, and lung-cancer screening for at-risk patients, among other things. In doing so, it also elevates mental health to a higher priority in primary care.”
The American Academy of Pediatrics made a statement earlier this year advocating that every child, over the age of 12, should be screened for depression.
The Patient Health Questionnaire (PHQ-2) is the universal depression-screening test that is given to patients. This questionnaire targets signs and symptoms of depression and specifically inquires how often do individuals experience these symptoms over a two week period; not at all, several days, more than half the days or nearly everyday. The 2 items are asked on this initial screening tool include “Little interest or pleasure in doing things” and “Feeling down, depressed, or hopeless.” If the patient responds affirmatively to either of the two items on the PHQ-2, the following seven questions on the PHQ-9 are asked.
- Trouble falling or staying asleep, or sleeping too much?
- Moving or speaking so slowly that other people could have noticed?
Or the opposite – being so fidgety or restless that you have been moving around a lot more than usual? - Trouble concentrating on things, such as reading the newspaper or watching television?
- Feeling bad about yourself – or that you are a failure or have let yourself or your family down?
- Poor appetite or overeating?
- Feeling tired or having little energy?
- Thoughts that you would be better off dead, or of hurting yourself in some way
Unfortunately regular depression screening does not happen at every doctor-patient encounter and as a result it is important for individual to talk to their doctors or health care providers if they are experiencing signs and symptoms associated with depression. There are also many credible online resources, hotlines and community groups that provide information on depression and can help an individual receive the proper care. Avoiding treatment can lead to a worsening prognosis and can result in the development of co-occurring disorders.
Other depression screening tools available:
- 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)
Treatment approach for depression
Treatment for depression consists of a combination of medications and psychotherapy. Although studies have shown that these medications and psychotherapy approaches can be used alone for mild depression, when used in combination, individuals receive the best outcomes in terms of symptoms relief for moderate depression. The most common pharmacological treatments include antidepressant classes such as selective serotonin reuptake inhibitors (SSRIs), serotonin/norepinephrine reuptake inhibitors (SNRIs), atypical antipsychotics, and tricyclic antidepressants (TCAs). Medication generally takes approximately 6-8 weeks for results to take effect. Psychotherapy includes cognitive behavioral therapy, interpersonal therapy, problem solving therapy and mindfulness-based cognitive therapy.
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