Implementing systematic depression screening in primary care: lessons from the MDD Minds global quality improvement...

Area of Science:

• Global Health
• Primary Care Medicine
• Mental Health Integration

Background:

• Depression is underdiagnosed in primary care, especially in low- and middle-income countries (LMICs).
• Limited evidence exists on practical strategies for integrating mental health screening into primary care in diverse international settings.
• This study addresses the need for feasible implementation strategies for depression screening in primary care.

Purpose of the Study:

• To evaluate the feasibility of implementing practice-driven, systematic depression screening.
• To assess screening among adult patients with diabetes mellitus (DM) in primary care settings across four countries.
• To inform strategies for integrating mental health into chronic disease management globally.

Main Methods:

• A 12-week quality improvement pilot (MDD Minds initiative) was conducted in nine primary care practices across Brazil, Japan, Kenya, and Nigeria.
• Practices received local coaching, educational resources, and adaptable workflow tools for screening adult patients with DM for depression during routine visits.
• Data on screening rates, depression identification, and resource provision were collected using standardized forms.

Main Results:

• Out of 1,592 adult patients with diabetes, 582 (36.6%) were newly screened for depression.
• Practices without prior depression documentation identified depression in 54.9% of screened patients, versus 12.2% in those with documentation, highlighting under-detection.
• A total of 326 patients (19.6%) were diagnosed with depressive symptoms (18.0% from positive screens, 13.3% with prior diagnoses).

Conclusions:

• Systematic depression screening integrated into routine diabetes care is feasible across diverse primary care settings.
• Adaptable workflows and structured coaching are crucial for successful implementation.
• Local ownership and context-specific strategies are vital for integrating mental health screening into global primary care chronic disease management.