SCREENING FOR DEPRESSION IN MEDICAL PATIENTS - IS THE FOCUS TOO NARROW

There is growing consensus that depression is a major public health pr oblem causing significant psychosocial morbidity and mortality which s hould be addressed by casefinding efforts in primary care settings. A large amount of literature has examined the ability of self-report que stionnaires to detect depression in medical patients and the results h ave been encouraging. However, studies of general population and psych iatric patient samples indicate that depression is frequently comorbid with other psychiatric disorders, and that psychiatric disorders othe r than depression are also associated with significant morbidity and m ortality. Consequently, we believe that psychiatric screening in prima ry care should be broad based. We administered a newly developed, mult idimensional questionnaire (the SCREENER), that simultaneously screens for a range of DSM-III-R psychiatric disorders, to 508 medical outpat ients attending a VA general medical clinic. Compared with nondepresse d cases, the depressed patients significantly more often reported all of the nondepressive symptoms. Nine of the ten nondepressive disorders screened for by the SCREENER were significantly more frequent in the depressed group. Most patients who screened positive for depression al so screened positive for at least one nondepressive disorder. Compared with patients who only screened positive for depression, those who sc reened positive for both depression and a nondepressive disorder rated their physical and emotional health more poorly and made more visits to the doctor. Compared with patients who did not screen positive for any disorder, those who only screened positive for a nondepressive dis order rated their physical and emotional health more poorly, and more frequently had a history of mental health treatment.