Study: Detecting Depression Rarely Requires Psych Visit

A UT Southwestern study shows that seeing a psychiatrist is not necessarily the most practical solution to diagnosing and treating depression. The research looked at 25,000 patients and concluded that primary care doctors can successfully detect and treat depression without additional help from mental health personnel, and arrives with guidelines asking for expanded depression screenings.

“It’s difficult to do proper screening for depression in a busy clinical practice,” says founding Director of UT Southwestern’s Center for Depression Research and Clinical Care, Dr. Madhukar Trivedi, per release. “This study shows that primary care physicians can do this, and do it well, with the right tools.”

The study supplied physicians with VitalSign6, a UT Southwestern developed software that provides patients with a questionnaire via a hand-held tablet at the beginning of their visit. The program also equips physicians with guidance on determining diagnosis, prescribing treatments, and monitoring patient’s progress.

For two years, the study tracked patients across 16 primary care clinics in the Dallas area. Each of the clinics employed the use of VitalSign6. From 2014 to 2016, 17 percent of patients screened positive for depression, and more than half were officially diagnosed.

The results of the study were published in the Annals of Family Medicine, and showed that patients experienced similar outcomes to those seen in psychiatric care. Nearly half of patients that had three or more visits post-diagnosis overcame their depression— a remission rate comparable to the world’s largest depression study, STAR*D, conducted by Trivedi more than a decade ago.

The project is one of multiple efforts conducted in recent years to help doctors follow revised national guidelines that call for screening of all patients 12 and older, and to subdue a growing depression rate. However, implementing this change has come slower than expected. A 2017 Psychiatric Services study showed that less than 5 percent of patients received mental health screenings.

Doctors cited heavy patient caseloads and lack of personnel with the expertise to treat depression as two reasons for the low rates. Proponents of the software say such issues can be combatted with the help of better tools, particularly measurement-based systems that allow physicians to track patient progress and adjust treatments as necessary.

“Measurement-based care is what truly differentiates the VitalSign6 approach,” says Executive Director of Woven Health Clinic—one of the sites included in the study—, Lisa Rigby, per release. “I’m shocked at how other health care providers are trying to screen and treat depression, if they’re doing so at all. It’s common to see a one-time screen, with perhaps a prescription and no follow-up to see if the treatment is working.”

VitalSign6’s implementation is expanding across North Texas, from hospitals and clinics to foster care and ministries that provide health care to low income patients. Additionally, the software has been integrated into a major electronic health record system used in large medical centers such Children’s Health and UT Southwestern, simplifying the tracking of patient’s progress throughout treatment.

Moving forward, Dr. Trivedi’s team is continuing to collect data on patient screening, including from children in pediatric clinics and women suffering from postpartum depression. The results found will be incorporated into related research that helps doctors recognize biological markers for depression, and discern which treatments are most appropriate.

Presently, Dr. Trivedi hopes this latest research will urge more primary care physicians to implement mental health evaluations into all their patients visits.

“Doctors test a patient’s blood pressure, pulse, and other vital signs,” says Dr. Trivedi, per release. “I would like the VitalSign6 study to show patients and primary care physicians that it’s just as important to test for the sixth vital sign- depression.”

Further information on the study and VitalSign6’s implementation can be found here.