Expanding Access to Psychiatric Care Through Universal Depression Screening: Lessons from an Urban Student-Run Free...

Area of Science:

• Public Health
• Psychiatry
• Primary Care

Background:

• Student-run free clinics (SRFCs) serve vulnerable populations.
• Access to mental health services, particularly psychiatric care, is often limited for uninsured individuals.
• Depression is a common condition that significantly impacts overall health and well-being.

Purpose of the Study:

• To evaluate the effectiveness of universal depression screening using the Patient Health Questionnaire (PHQ-9) in an SRFC.
• To assess the utility of this screening in facilitating referrals to psychiatric care.
• To identify characteristics of patients who accept or decline psychiatric referrals.

Main Methods:

• A retrospective chart review of 224 patients seen at an SRFC between April 2017 and November 2022.
• Patients were screened for depression using the PHQ-9 in their primary language.
• A PHQ-9 score of 5 or higher prompted a referral to an adjacent psychiatry clinic.

Main Results:

• 77 out of 224 patients (34.4%) had positive depression screens and were referred.
• Of those referred, 37 patients (48%) accepted the referral, while 40 (52%) declined or were lost to follow-up.
• Patients who accepted referrals were more likely to be female, have prior psychiatric history, higher PHQ-9 scores, and a history of trauma.

Conclusions:

• Universal depression screening is a valuable tool for identifying unmet mental health needs in urban, uninsured primary care settings.
• SRFCs can effectively implement depression screening to bridge the gap to psychiatric care.
• Barriers to psychiatric care acceptance include insurance transitions, relocation, and hesitancy towards seeking mental health services.