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Depression screening
underway in New York
(June
2005 Issue)
By Jennifer Chase Esposito
Doctors in New York working with the Health and Hospitals Corporation
are hoping to detect a person's tendency toward depression via a
new test program that could become as regular a part of your yearly
physical upkeep as having your teeth cleaned.
According to a New York Times article, this new program's goal
is to use a scored test, given by patients' primary care physicians,
as part of a large-scale screening plan for mental disorders.
The test, given only to adults, asks nine questions such as whether
a patient has in a two-week period felt "depressed, down or hopeless."
Patients can check off the category that best describes their level
of feelings: nearly every day, more than half the days, several
days or not at all. A high score wouldn't deem someone depressed,
but it would lead a primary care physician to suggest more in-depth
screening.
Similar programs to New York's were created two years ago after
President Bush's New Freedom Commission on Mental Health earmarked
$20 million for mental health screening. Connecticut has a similar
survey to help target substance abuse prevention and holds a Depression
Awareness Day where depression screenings are administered; Texas
had the Medication Algorithm Project that screened people for mental
illness.
At the time, there were rumblings that the president's commission
and subsequent programs were nothing more than a set-up for drug
companies to potentially prosper. But depression screenings aren't
new: the Zung Self-Assessment Depression Scale and the Beck Depression
Inventory are just two that use fairly basic questioning to determine
whether someone has a level of depression.
Surveys have found that approximately 46 million people in the
United States suffer from one form of depression or another. Members
of New England's mental health community seem to feel that New York's
test - which would be administered by primary care physicians -
is a step in the right direction toward helping those patients a
little earlier.
"Given the prevalence of mental illness and the serious implications
for failing to recognize mental illness, screening is an important
and necessary component of health care - just like screening for
other forms of serious illness," says Elizabeth Childs, M.D., commissioner
of the Massachusetts Department of Mental Health. But like all medical
screening, she says qualified practitioners must do it in confidence.
"The goal is to change medical practice, so that practitioners
become sensitive to the signs of mental illness, conduct appropriate
screenings, and provide treatment accordingly," she says.
In spite of her approval of screenings in general, Childs offered
no comment on the particular instrument being used in New York.
"The intent [of this program] is good," says Kenneth Marcus, M.D.,
medical director of the Connecticut Department of Mental Health
and Addiction Services. "On the face of it, it's a very good intervention.
It allows you to identify an undiagnosed condition that is potentially
treatable….[And] there is good data that people either reveal or
are more likely to reveal depressions to their primary care physician."
But in order for the depression screening to work, says Marcus,
primary care physicians administering the test must be properly
trained in identifying depression and offering proper treatment.
James Siemianowski, LICSW, agrees. Siemianowski is senior policy
advisor to Commissioner Thomas A. Kirk Jr., Ph.D., also of Connecticut's
Department of Mental Health and Addiction Services. Siemianowski
says New York's questionnaire is a good identifier of people with
major mental illness who might otherwise go untreated; but the most
important thing in his mind is appropriate follow-up.
"Many people do end up receiving mental health care through primary
care routes….[But] if we were to evaluate [that] we would want to
ensure there would be some protection" for the client, he says.
If people take the questionnaire, he says, and a primary care physician
finds them depressed, the person doing the diagnosing is going to
have to provide some resources.
There is, of course, the risk of over-diagnosing says Siemianowski.
"Certainly within our profession I think early intervention and
early identification is a good thing. And while I say that, the
reality is the general public and, I think, society in general,
does stigmatize people for mental illness. So I think clearly early
identification … can alter the course of a public position."
Opponents have questioned the confidentiality of the questionnaire,
but Siemianowski sees no breaching of doctor-patient confidence.
"The information isn't going to be shared with anybody," he said.
"It's not like I'm going to do a questionnaire on you and find you
depressed and then share that with somebody else…."
According to the New York Times article, no federal money is being
used for the program, which is currently underway in hospitals run
by the city.
Although New York is the first to use a test like this on such
a wide scale, it may take a while before other states catch on.
New England is awaiting more evidence before it starts editing questionnaire
questions.
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