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By Allen Cone, UPI
Primary care physicians rarely package depression assessments with patient screenings for hazardous alcohol use, according to a study.
In research published this week in the Journal of the American Board of Family Medicine, scientists found screenings identify symptoms of depression that doctors may not otherwise notice. Primary care settings are an "untapped resource" to treat depression, according to first author Dr. Matthew Hirschtritt, a forensic psychiatry fellow at University of California San Francisco.
Overall, depression screening is part of about 1.4 percent of adult ambulatory care visits nationwide.
Screening rates are particularly low among men in general, non-white people and more medically ill patients.
"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," Hirschtritt said in a press release.
Primary care practitioners are advised to screen for depressive symptoms using an instrument known as the Patient Health Questionnaire 9, according to U.S. Preventive Services Task Force recommendations.
"Depressive symptoms are extremely common, but we know many people don't make it to specialty psychiatric treatment," said Dr. Stacy Sterling of Kaiser Permanente Northern California's Division of Research. "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."
Studied were more than 2.8 million Kaiser Permanente Northern California primary care patients who had been screened for hazardous alcohol use. Patients were asked how many days they typically drank per week, and the number of drinks per day. Hazardous use was defined as more than 14 drinks a week for men 65 and younger, and more than seven drinks a week for women and men 66 and older.
Kaiser Permanente's slogan is "We ask everyone" -- every adult primary care patient can expect to be screened about alcohol use.
The researchers found that among Kaiser Permanente patients screened for hazardous alcohol use, 2.4 percent were also screened for depression within the next 30 days -- consistent with estimates from national surveys.
"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," Hirschtritt said.
Although non-white patients were less likely to be screened for depression than white ones, they were more likely to report clinically significant depressive symptoms, the authors found.
"It's unclear why non-white individuals weren't screened at a higher rate," Hirschtritt said. "These patients may face multiple stressors that put them at a higher risk for depression, in addition to hazardous alcohol use."
Approximately 8.1 percent of U.S. adults have exhibited significant depressive symptoms in the past two weeks and 21.6 percent have had some depressive symptoms at some point, Hirschtritt said.
The overall rate of major depression was 4.4 percent in 20, rising 33 percent since 2013, according to a Blue Cross Blue Shield Association analysis of medical claims data released in May. Those rates increased 63 percent among teens and 47 percent among millennials.
"The Alcohol as a Vital Sign initiative has resulted in extremely high screening and brief intervention rates," Sterling said. "It could make a difference if we established a similar protocol for depression."
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