Study Suggests Gap between Veterans Screening Positive for Depression and Those Receiving Timely Guideline-Concordant Treatment
In 2016, the United States Preventive Services Task Force newly recommended universal screening for depression, with the expectation that screening would be linked to appropriate treatment. For more than two decades, VA has mandated annual depression screening in primary care and currently achieves near-universal screening rates among clinics nationally. This retrospective cohort study examined adherence to guidelines for follow-up and treatment among primary care patients who newly screened positive for depression. Using VA data, investigators identified 15,155 Veterans – from a cohort of 607,730 – who had newly screened positive for depression, and who had been diagnosed by a clinician as having depression (assessed via diagnostic coding or antidepressant prescription). Study participants had been seen in any of 82 VA primary care clinics between October 1, 2015 and September 30, 2019. Investigators examined associations between the quality of depression care and patient (i.e., comorbidities) and clinic characteristics (i.e., community vs hospital-based clinic, rural vs urban setting). The main outcome was the receipt of guideline-concordant depression care, which included timely follow-up (specified visits within 84 and 180 days of screening positive) and at least minimally appropriate treatment, such as having ≥60 days of antidepressant prescriptions, ≥4 mental health specialty visits, or ≥3 psychotherapy visits within 12 months of screening positive.
- Only a minority of Veterans in this study received timely follow-up after screening positive for and being identified as having depression. While 77% met guidelines for completing at least minimal treatment in 1 year, only 32% received timely clinical follow-up within 3 months of screening.
- Younger age and comorbid mental illness were significant predictors of higher quality depression care. For example, predicted probabilities for timely follow-up among VA patients with and without PTSD were 38% and 24%, respectively, and 85% and 72% for treatment.
- More research is needed on whether the discrepancy between patients who screened positive and those who were then identified by a clinician as having depression reflects a gap in recognition of needed care or over-detection from universal screening.
- Results are based on administrative data, thus coding inaccuracies may present limitations.
This study was partly funded by HSR&D, and Dr. Leung is supported by an HSR&D Career Development Award. Drs. Leung, Rose, Stockdale, Wells, and Ms. Chu are part of HSR&D’s Center for the Study of Healthcare Innovation, Implementation, and Policy (CSHIIP). Dr. Post is part of HSR&D’s Center for Clinical Management Research (CCMR).
Leung L, Chu K, Rose D, Stockdale S, Post E, Wells K, and Rubenstein L. Electronic Population-based Depression Detection and Management through Universal Screening in the Veterans Health Administration. JAMA Network Open. March 10, 2022; 5(3):e221875.