Recent JAMA recommendations for adult depression screening

[kalibex]

From the Jan. 26th issue:

Although the USPSTF report clearly supports routine screening for adults, it acknowledges that the optimal frequency of such screening has not been established. One reason for such uncertainty is that the benefits of screening are directly linked to the probability that a given patient or group of patients will become depressed during a specific time interval. For people with a history of depression, it would make sense to “screen” for illness activity at each visit. For groups at intermediate risk, such as patients receiving regular care for chronic medical conditions such as diabetes or heart disease, it is reasonable to screen at least once each year. For patients in generally good health who only see their primary care physicians sporadically, it may make sense to screen at each visit, although it is likely that a person who rarely sees a physician may not necessarily schedule an appointment to see a primary care physician within weeks or even months of onset of a depressive syndrome. For such individuals, it may more sense to incorporate periodic web-based “health checks.”

JAMA. 2016;315(4):349-350. doi:10.1001/jama.2015.18406.

Bottom line: The US Preventive Services Task Force (USPSTF) wants more frequent screenings. I'm assuming this will end up integrated into the treatment guidelines, to ostensibly allow more suffering people to get treated... but I think we all know where this is headed...

FX: SOUND OF CASH REGISTER OPENING

 

[Yupo]

I noticed this and similar flags popping up on electronic medial records lately:

Screening: Clinical depression screen indicated (document follow-up plan if positive).

Citation: Pratt L.A. & Brody DJ, NCHS Data Brief (2008). Sep;(7):1-8. Depression in the United States household population, 2005-2006.; Borner, I., Braunstein, J. W., St. Victor, R., & Pollack, J. (2010). Evaluation of a 2-Question Screening Tool for Detecting Depression in Adolescents in Primary Care, Clinical Pediatrics 49(10) 947–9532010

There are also flags for BMI counseling, various vaccine prods, etc.

 

[Echo Blue]

Well, my 31 year old son who was born with Down's Syndrome had his physical at the end of November 2015. The questions that the nurse asked him after taking the usual blood pressure, height/weight was extremely invasive and I pretty much held my breath as I did not know how my son would answer some of these very personal questions - questions of the type he has never been asked before. For example he was asked if he "ever felt depressed". What an open ended question.

He was asked if ever felt that he was in danger in his home. Unfortunately, I can't remember many of the other questions he was asked - questions that probably numbered in the range of about 12-15 questions on his mental health status.

Only once of twice did he look to me for help in answering, and the nurse said that he needs to answer on his own. In the end I was amazed that he pretty much said he was a happy-go-lucky guy!!! But, what about the pre-teens that go in without their parents. There were questions about guns in the house. Does anyone hit you. Does anyone yell at you. Are you sexually active. Questions asking if anyone in the home makes you feel unsafe (this was the one he had a bit of trouble with).

This was the first time questions of such an intimate nature were asked of my son (besides the usual questions of health eg. do you smoke, drink....... The practice knows me and my son. They know I refuse all immunizations and are ok with this. And, in the end, the nurse apologized for having to ask such personal questions, but that this was now their standard protocol for all physicals. UGH...............

 

[Yupo]

What I find disturbing is that this information is being collected digitally. Remember the old expression, parents warning us about behavior things going on our permanent record? They were right!