Yield of practice-based depression screening in VA primary care settings

Area of Science:

• Primary care research
• Mental health screening
• Implementation science

Background:

• Many patients requiring depression treatment are missed due to inadequate screening in primary care (PC).
• The Veterans Affairs (VA) mandates annual PC depression screening, but its real-world yield is not well understood.

Purpose of the Study:

• To assess the effectiveness of practice-wide depression screening in diverse PC settings.
• To characterize the care needs of patients identified with depression through screening.

Main Methods:

• A group randomized trial involving 10,929 patients across ten VA PC clinics.
• Utilized Patient Health Questionnaire (PHQ-2) followed by PHQ-9 for positive screens.
• Collected sociodemographic and health status data.

Main Results:

• 20.1% of patients screened positive; 11.8% had probable major depression (PHQ-9).
• High rates of comorbid mental illnesses (anxiety, PTSD) and chronic medical conditions were observed.
• Nearly one-third of depressed patients reported suicidal ideation; sexual dysfunction was prevalent and often untreated.

Conclusions:

• Practice-wide screening identified more than double the positive cases compared to chart reviews.
• Comorbidities necessitate integrated care models, not solely PC or mental health specialist management.
• Effective implementation requires systems-level support for mental health assessment, treatment, and referral within PC.