Missed Opportunities for Depression Screening in Patients with Arthritis in the United States |
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Authors: | Mary E. Margaretten MD MS Patricia Katz PhD Gabriela Schmajuk MD MS Edward Yelin PhD |
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Affiliation: | 1. Division of Rheumatology, Department of Medicine, University of California San Francisco, San Francisco, CA, USA 3. Arthritis Research Group UCSF, 3333 California Street, Suite 270, San Francisco, CA, 94118, USA 2. Division of Rheumatology, Department of Medicine, San Francisco VA Medical Center, San Francisco, CA, USA
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Abstract: | BACKGROUND Arthritis affects 20 % of the adult US population and is associated with comorbid depression. Depression screening guidelines have been endorsed for high-risk groups, including persons with arthritis, in the hopes that screening will increase recognition and use of appropriate interventions. OBJECTIVE To examine national rates of depression and depression screening for patients with arthritis between 2006 and 2010. PARTICIPANTS AND DESIGN We used nationally representative cross-sections of ambulatory visits in the United States from the National Ambulatory Medical Care Survey from 2006 to 2010, which included 18,507 visits with a diagnosis of arthritis. When weighted to the US population, this total represents approximately 644 million visits. MEASUREMENTS Visits where arthritis was listed among diagnoses. Outcomes were survey-weighted estimates of depression and prevalence of depression screening among patients with arthritis across patient and physician characteristics. KEY RESULTS Of the 644,419,374 visits with arthritis listed, 83,574,127 (13 %) were associated with a comorbid diagnosis of depression. The odds ratio for comorbid depression with arthritis was 1.42 (95 % CI 1.3, 1.5). Depression screening occurred at 3,835,000 (1 %) visits associated with arthritis. When examining the rates of depression screening between ambulatory visits with and without arthritis listed, there was no difference in depression screening rates; both were approximately 1 %. There was no difference in screening rates by provider type. Compared to visits with other common, chronic conditions, the prevalence of depression at arthritis visits was high (13 per 100 visits), although the prevalence of depression screening at arthritis visits was low (0.68 per 100 visits). CONCLUSIONS Despite the high prevalence of depression with arthritis, screening for depression was performed at few arthritis visits, representing missed opportunities to detect a common, serious comorbidity. Improved depression screening by providers would identify affected patients, and may lead to appropriate interventions such as mental health referrals and/or treatment with anti-depressants. |
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