National Depression Screening Day 2010 is tomorrow Thursday, October 7th.  This annual event is important as depression is a prevalent medical illness and the consequences of poorly treated depression include emotional suffering, increases in health expenditures, morbidity, higher risk of suicide, and mortality from other causes. It’s especially important to screen for depression in home care patients because clinically significant depression is twice as prevalent in the home healthcare service sector compared to primary care. But depression is treatable in most cases.

Depression Screen

The OASIS-C depression item (M1730) provides both structure and flexibility in depression screening.  Screening patients for depression can identify persons in need of interventions and lead to improvements in the well-being of seniors.  Brief screens can be administered at minimal personnel cost and may lead to a decrease in overall healthcare costs.

You may be wondering, what it means when a depression screen is positive? My colleague, Dr. Martha Bruce and I discussed this during a  VNAA webcast, “The Depression Screen is Positive: What is the Next Step?,” in July.

A positive depression screen:
• Does not necessarily indicate that a patient has clinically significant depression.
• It does indicate the need for further evaluation of depression severity, suicide ideation, and depression treatment needs.

Depression is a chronic illness with an episodic course and like other chronic illnesses, depression treatment requires ongoing care management.  Our research and that of others has demonstrated that when a patient with a currently prescribed antidepressant has a positive depression screen the clinician may incorrectly assume that further evaluation is not needed.  A depression screen is true whether or not patients are currently taking antidepressants.  Inadequate treatment is common (resulting in ongoing depressive symptoms) and patients need ongoing monitoring and management.

Here are a few other depression screening tools that can also be found on CHAMP’s web site:
1. Cornell Scale for Depression in Dementia (CSDD)
2. Geriatric Depression Scale (GDS)
3. Patient Health Questionnaire (PHQ-2)

Interventions in Home Care

We have developed a structured communication approach to efficiently and effectively communicate assessment information to the patient’s physician or primary care provider when depression is suspected.  We tested this intervention with home care nurses and it was found to be helpful and saved time. If you wish to learn more about this approach you can read about it here and you can read about an evidence-based depression screening program  by clicking here.

Depression screening often only takes a few minutes but adequate depression treatment can make a significant difference in the lives of our patients and their families.

Ellen Leslie Brown, Associate Professor
College of Nursing and Health Sciences
Florida International University