Depression Screening Less Common for Men and Minorities

Matthew Hirschtritt, MD, MPH

Just 2.4% of participants in a study of primary care patients asked about hazardous alcohol use were also screened for depression.

Additionally, investigators found that patients at higher risk of exhibiting depressive symptoms were among those least likely to be screened for depression using the Patient Health questionnaire 9 (PHQ-9).

"Our study provides evidence that, with a simple questionnaire, primary care doctors have a big opportunity to better spot depressive symptoms in at-risk patients and help improve their lives through treatment," said Matthew Hirschtritt, MD, MPH, a forensic psychiatry fellow at UC San Francisco and first author of the new study.

The study used cross-sectional data from 2,894,906 primary care patients at Kaiser Permanente of Northern California (KPNC) who participated in an alcohol screening and intervention initiative, Alcohol as a Vital Sign. Investigators examined whether those patients were given the PHQ-9 within 30 days of the study visit and if so, whether their scores met the minimum threshold for depressive symptoms.

Investigators found that 2.4% (n = 68,686) of patients were asked to complete the PHQ-9 within 30 days of their alcohol-use screening. Among those screened patients, 47.2% (n = 32,390) reported significant depressive symptoms in the past 2 weeks.

"Depressive symptoms are extremely common, but we know many people don't make it to specialty psychiatric treatment," said the paper's senior author Stacy Sterling, DrPH, of the Division of Research of KPNC. "Many people do already have a strong relationship with their primary care provider, so it may actually be the perfect environment for behavioral health intervention."

However, the authors noted that screening for depression was not administered evenly across gender, racial, and ethnic groups. Men were not screened as often as women: 1.76% of men were screened for depressive symptoms while 2.90% of women were screened with the PHQ-9.

"The finding that I found most concerning is that individuals who self-identified as white were more likely to receive screening than were historically marginalized ethnic groups," said Hirschtritt. "These patients may face multiple stressors that put them at a higher risk for depression, in addition to hazardous alcohol use."

Based on self-reported race and ethnicity data recorded during the patients’ intake evaluation, the study found that white patients were more likely to have been screened for depression (2.81%) than Blacks/African Americans (2.12%), Asians (1.24%), Hispanics (2.50%), and those who selected “other” or whose race was unknown (2.26%).

The authors noted that the study did not examine why certain patients were screened for depression and added that future study is needed in this area.

"The Alcohol as a Vital Sign initiative has resulted in extremely high screening and brief intervention rates," said Sterling. "It could make a difference if we established a similar protocol for depression."

The study, “Depression Screening Rates and Symptom Severity by Alcohol Use Among Primary Care Adult Patients,” was published in the Journal of the American Board of Family Medicine.