For years, mental health screening in primary care has meant one thing: a depression questionnaire. It was an important start. But the research now makes clear that screening for one condition at a time leaves too much of the picture unexplored.

Mental health conditions rarely travel alone

In the landmark National Comorbidity Survey Replication of 9,282 U.S. adults, 45% of people with a mental health condition in the past year met criteria for two or more.1 Anxiety, depression and substance use often appear together, and each one changes how the others should be treated.

A depression-only screen can find the depression and miss what’s underneath it.

Patients don’t always say what’s wrong

In an international study published in the New England Journal of Medicine, 69% of primary care patients who met criteria for depression reported only physical symptoms as the reason for their visit: headaches, back pain, fatigue and poor sleep.2

If screening depends on the patient bringing it up, most never will.

Bipolar disorder hides behind depression

In a JAMA study of 1,157 primary care patients, 9.8% screened positive for bipolar disorder. Only 8.4% of them reported ever receiving that diagnosis, and none had it recorded in their primary care chart. Nearly half had current depression noted by their physician.3

That matters because bipolar depression and major depression call for different treatment. Checking for bipolar disorder before treating depression is one of the most important safeguards a practice can have.

The primary care visit is often the last chance

A review in the American Journal of Psychiatry found that, on average, 45% of people who died by suicide had contact with a primary care provider in the month before.4 Many of those visits were about something else entirely.

The guidelines have caught up

The U.S. Preventive Services Task Force now recommends that clinicians screen:

  • All adults for depression, including pregnant and postpartum patients (2023).5
  • Adults 64 and younger for anxiety, a first-ever recommendation (2023).6
  • Adults for unhealthy drug use (2020).7
  • Children and teens for anxiety (ages 8–18) and depression (ages 12–18) (2022).8,9

Following every recommendation with separate questionnaires adds up quickly. That’s why practices are moving to multi-condition screening.

What modern screening and testing looks like

The approach we help practices adopt brings these recommendations together in one workflow. According to its developer:

  • One screen, six conditions: eight yes/no questions, about one minute, covering depression, anxiety, ADHD, bipolar disorder, substance use and somatic symptoms.
  • High accuracy: rules out all six with 97% weighted negative predictive power, and is validated, peer-reviewed and published in the Journal of Clinical Psychology in Medical Settings.
  • Testing only when needed: if anything is flagged, targeted testing follows automatically, usually in 2 to 5 minutes, with built-in suicide-risk assessment and a bipolar check before depression treatment.
  • For patients 12 and up, in the office on a tablet or through a secure link before a virtual visit, with results delivered to the EHR.

See how it works at thedaceygroup.co/learn.

Sources

  1. Kessler RC, et al. Prevalence, severity, and comorbidity of 12-month DSM-IV disorders in the National Comorbidity Survey Replication. Archives of General Psychiatry. 2005;62(6):617–627. pubmed.ncbi.nlm.nih.gov
  2. Simon GE, et al. An international study of the relation between somatic symptoms and depression. New England Journal of Medicine. 1999;341:1329–1335. www.nejm.org
  3. Das AK, et al. Screening for bipolar disorder in a primary care practice. JAMA. 2005;293(8):956–963. pubmed.ncbi.nlm.nih.gov
  4. Luoma JB, Martin CE, Pearson JL. Contact with mental health and primary care providers before suicide: a review of the evidence. American Journal of Psychiatry. 2002;159(6):909–916. pubmed.ncbi.nlm.nih.gov
  5. U.S. Preventive Services Task Force. Screening for Depression and Suicide Risk in Adults. June 2023. www.uspreventiveservicestaskforce.org
  6. U.S. Preventive Services Task Force. Anxiety Disorders in Adults: Screening. June 2023. www.uspreventiveservicestaskforce.org
  7. U.S. Preventive Services Task Force. Screening for Unhealthy Drug Use. June 2020. www.uspreventiveservicestaskforce.org
  8. Office of Disease Prevention and Health Promotion. Anxiety in Children and Adolescents: Screening (USPSTF, October 2022). odphp.health.gov
  9. U.S. Preventive Services Task Force. Depression and Suicide Risk in Children and Adolescents: Screening. October 2022. www.uspreventiveservicestaskforce.org

Disclosure: The Dacey Group works with mental health screening partners and may be compensated when practices adopt their programs. Product details are based on information provided by the platform’s developer. This article is for informational purposes for healthcare professionals and is not medical advice. If you or someone you know is in crisis, call or text 988 in the U.S.

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