How Physicians Try to Spot Depression

L. Landro, Wall Street Journal, Dec. 7, 2010

Seeming nervous and overcome during a regular visit with her primary-care provider, Lucy Cressey was prescribed an anti-anxiety medicine and referred for talk therapy with a social worker.

The treatment recommendations occurred after Ms. Cressey agreed to complete 2 questionnaires during the medical examination visit at the John Andrews Family Care Center in Boothbay Harbor, ME, last year. Ms. Cressey scored high on both questionnaires, fashioned to help clinical depression and anxiousness.

Following the recent demise of her dearest friend, a tough spinal operation and many household fiscal woes, "many stressors simply snowballed for me," states Ms. Cressey, a 52-year-old veterinary technician. "But in pastoral Maine it is not so fashionable to discuss being dispirited or apprehensive, and those questionnaires truly open some doors for them to assist you."

A rising amount of primary-care suppliers are employing screening instruments to evaluate clinical depression and additional mental-health conditions during routine-care visits. They're likewise organizing care of dispirited patients with behavioral-health specialists. Such supposed mental-health-consolidation platforms have been demonstrated to cut down emergency-room visits and mental hospital admittances, and to increment employees' productiveness at work.

One in 4 American adults who see their primary-care physicians for a regular medical exam or bodily complaint likewise suffer from a mental-health problem, federal data establish. But patients frequently do not evoke the subject and physicians are too occupied to inquire. As a consequence, a lot never receive treatment: Less than thirty-eight% of adults in the United States. with mental disease obtained care for it last year, according to the federal drug abuse and Mental Health Services Administration.

A number of healthcare groups act in tandem with behavioral-health providers. And many underwriters, including Aetna, are advertising incorporated care. Approximately 5,000 doctors take part in Aetna's Depression in Primary Care platform, which reimburses them for distributing a Patient wellness Questionnaire, or PHQ-9, to patients. Aetna is likewise educating behavioral-health specialists, and placing them in primary-care agencies.

Health groups progressively acknowledge that physiological and emotional wellness are entwined. Numerous patients with mental-health troubles possess 2 or more additional issues such as heart condition, obesity or diabetes. As many as seventy% of primary-care visits are set off by implicit mental-health issues, according to behavioral-health investigators.

Intermountain Health in Salt Lake City, UT, employs the PHQ-9 depression-screening instrument in approximately 70 of its 130 medical practices. "The design is to ascertain if we stabilize patients and get them healed in primary care, or whether we need to transition them to a behavioral-health expert," states Brenda Reiss-Brennan, manager of the Intermountain Mental Health Integration platform.

Wayne Cannon, an Intermountain doctor helping direct the endeavor, states that patients who are required to complete the PHQ-9 form may be categorized as mildly, somewhat or gravely depressed. Grading programs on the questionnaires include guideposts to assist physicians ascertain whether patients require simply vigilant waiting, medication or a class of psychotherapeutics. Patients can be directly attended by a behavioral-health specialist in what's called a "warm hand-off," Dr. Cannon alleges, making them more at ease and probable to follow up with treatment.

Amy Young, a 32-year-old patient at Intermountain who has multiple sclerosis and takes antidepressant drugs, says her primary-care physician last year referred her to a psychologist who works in the same agency and knew about several battles confronted by multiple sclerosis patients. "Your primary-care physician can not talk to you for an hour at once like a therapist can," states Ms. Young. "They can speak to one another if they have doubts about anything taking place with me and I feel a great deal more at ease since I am used to going to the same office."

Intermountain states its own reports demonstrate that adult patients cared for in its mental-health consolidation clinics possess a smaller growth rate in billings for all services than those cared for in clinics without the service. It likewise observed that depressed patients cared for in the clinics are 54% less probable to undergo ER visits than are depressed patients in familiar care clinics.

Patients being treated for clinical depression should get the PHQ-9 exam regularly administered, states John Bartlett, ranking consultant in the mental-healthcare program at the noncommercial Carter Center in Atlanta, which encourages mental-health treatment in primary care. If physicians do not provide it or don't repeat it, patients should call for the exam on their own and alert their physician to any troubling grade, he states. The exam is accessible free online at

MaineHealth, a network of providers in the state that includes the John Andrews Center where Ms. Cressey is cared for, enrolled behavioral-health specialists to work in physicians' offices in various communities. Cynthia Cartwright, program manager, states MaineHealth produced an Adult welfare Screener merging queries from the PHQ-9 for clinical depression, and additional exams for anxiousness, manic depression and drug abuse. "It is difficult occasionally to bring down clinical depression symptoms to the enquiries upon a form, but you have to begin someplace, and I believe they help physicians acknowledge, inquire about and care for temper disarrays," alleges Debra Rothenberg, one of the doctors taking part in the plan.

Since behavioral-health services are generally handled individually under most insurance policy programs, physicians frequently have to instruct patients to seek out further mental-health care by calling up their insurance company for a referral. But a lot of patients do not follow up to establish the engagements, and there are oftentimes limits to their mental-health insurance coverage. That's changing as novel federal conventions take effect forbidding underwriters from laying out more rigorous limitations upon mental-health benefits than they do for some other sicknesses. And mental-health-consolidation programs are anticipated to acquire a boost from the new national health law, which includes financial support for plans producing "medical homes" that organize physical- and mental-health care for patients.

In the Aetna plan, the insurance company case directors help track patients' advancement and alert doctors whenever they're not improving. Case directors likewise help with referrals to other mental-health services.

Aetna's surveys demonstrate that on the average, patients finishing the case-management curriculum underwent a 4.7% growth in productiveness at work, based on a questionnaire assessing the impact upon productivity of employee wellness problems. Hyong Un, Aetna's head psychiatrical officer, states the insurance firm utilizes its personal registers to discover patients who could be prospects for clinical depression screenings, including those who have ceased filling their antidepressant drug prescriptions.

Richard Wender, chairperson of the department of family practice at Thomas Jefferson University in Philadelphia, states involvement in the Aetna program has helped prompt its physicians to dispense the screens and follow through with patients. Having a behavioral-health medical specialist in the same office "has helped us evaluate behavioral-health issues more often and get a program in place to deal with them," he states.



“Under the care of Leo J. Borrell, M.D. since December 2001, I have seen a remarkable improvement in my mother’s condition. She is responding dramatically to the new regiment Dr. Borrell has prescribed”

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