Published on January 12, 2008
Depression Screening in Transitional Health Care : Depression Screening in Transitional Health Care NYC Department of Health and Mental Hygiene, Office of Program Development September 16, 2005 Overview: Overview Depression Facts: general population NYC population forensic population Symptoms Risk factors/psychosocial stressors Detection, Screening and Referral Psychiatric Emergencies Treatment NYC DOHMH Depression Initiative Depression in the General Population: Depression in the General Population Approximately 18.8 million American adults, or about 9.5% of the US population age 18 or over in a given year, have a depressive disorder. It is estimated 1 in 4 women and 1 in 10 men will suffer from a Major Depressive Episode during the course of their lives. While Major Depressive Disorder can develop at any age, the average age of onset is the mid-twenties. Depressive disorders often co-occur with anxiety disorders and substance abuse. Depression in New York City: Depression in New York City 8% of all adult New Yorkers have a diagnosis of Major Depression. Of those diagnosed with Major Depression: 9.1% are female and 5.5% are male 9.4% Black, 7.9% White, and 7.3% Hispanic Depression in the Forensic Population: Depression in the Forensic Population In New York City, approximately 25% of the 130,000 inmates admitted annually to City Jails are in need of mental health treatment. 15,000 of these patients suffer from severe mental illness. Psychotic disorders, such as schizophrenia, and mood disorders, such as major depression and bipolar disorder, are the most common. Symptoms of Depression: Symptoms of Depression Persistent sad, anxious or empty mood Feelings of hopelessness, guilt, helplessness Loss of interest in hobbies Decreased energy, feel fatigued Difficulty concentrating, memory Appetite loss, weight loss/gain Thoughts of suicide, attempts at suicide Restlessness, irritability Sleep disturbance Established Risk Factors for Depression : Established Risk Factors for Depression Gender Race/ethnicity Having a parent who was depressed Chronic stress/Life events; psychosocial stressors are especially relevant for the Forensic population Poverty Chronic health problems Lack of social support Internalized racism Inmates’ Psychosocial Stressors: Inmates’ Psychosocial Stressors Inmates have multiple psychosocial stressors and medical/substance abuse issues that increase the risk of a depressive illness Personal and family histories of alcohol and substance abuse High rate of homelessness Lack of benefits, including health insurance High rate of unemployment Prior victimization; males (10%) and females (50%) Poor physical health; females 3x more likely to report poor health than the general population, high rate of HIV+ Detection of Depression: Why Screen?: Detection of Depression: Why Screen? To find people who may be depressed or at risk for depression who don’t know it Screening for depression in the primary care setting improves detection rates Failure to detect and treat depression leads to unnecessary suffering and disability and increases the use of health care services. How to Screen: Patient Health Questionnaire (PHQ) : How to Screen: Patient Health Questionnaire (PHQ) PHQ2 PHQ9 (used by health professional) PHQ 2: PHQ 2 A quick and simple screen for depression that consists of 2 questions During the past two weeks, have you been bothered by : 1. little interest or pleasure in doing things ? 2. feeling down, depressed, or hopeless? Referral Process: Referral Process If the patient responds “yes” to either question on the PHQ2: 1- referral made to primary care MD or mental health specialist 2- MD will administer the PHQ9, a 9-item questionnaire available in multiple languages that can quantify the severity of depression 3- MD confirms diagnosis through clinical interview 4- MD provides treatment; ie. medication and/or referral for psychotherapy Consequences of Untreated Depression: Consequences of Untreated Depression Untreated depression causes distress, disability, and, most tragically suicide. May increase: risky behaviors, ie. unprotected sex, drug and alcohol abuse behaviors that contribute to poor health, ie. smoking, poor nutrition risk of chronic medical illness, ie. cardiovascular disease, diabetes Depression and Suicide: Depression and Suicide More than 90% of those who commit suicide have a diagnosable psychiatric illness at the time of death, usually depression, alcohol abuse or both. Do not ignore remarks about suicide, active suicidal thoughts require immediate assessment by a health professional at the local emergency room. Psychiatric Emergencies: Psychiatric Emergencies Suicidal Ideation Homicidal Ideation Psychosis Call 911 immediately if any Psychiatric Emergencies Exist LIFENET (1 800 LIFENET) is staffed by mental health clinicians that can provide support to the public health advisor in a crisis situation Treatment: Treatment Treatment is effective Treatment includes medication, psychotherapy or both Type of treatment recommended depends on the type of symptoms, the severity of symptoms and the patient’s personal preferences Combined treatment with antidepressants and psychotherapy is recommended as first line treatment for patients with severe major depressive disorder Barriers to Treatment Among Ethnic and Racial Minorities: Barriers to Treatment Among Ethnic and Racial Minorities Mistrust and fear of treatment Different cultural ideas about illness, stigma Differences in health seeking behaviors, language and communication patterns Racism High rates of being uninsured Discrimination by individuals and institutions Stigma: Stigma Disproportionately affects certain age groups and ethnic/racial minorities To reduce stigma, it is important to emphasize that depression is like any other medical illness and is treatable NYC Dept of Health and Mental Hygiene (DOHMH): NYC Dept of Health and Mental Hygiene (DOHMH) Depression initiative seeks to assist PCP with implementing depression screening and management in primary care Most depression can be managed in primary care Depression is one of the most common conditions seen in primary care, although it is often undiagnosed, misdiagnosed and/or inadequately treated DOHMH can provide training and technical assistance to PCP on how to do depression screening and management Contact Information: Contact Information For PCPs interested in obtaining training and/or technical assistance on how to do depression screening and management, please call 212-219-5380.