Depression Diagnosis Requires Clinically Sound Evaluation

depression screening

Anecdotal stories and social media posts seem to indicate that depression is widespread in society. However, providers must rise above the noise and use clinically sound processes to accurately diagnose depression and assess patient needs.

It’s true that many patients who feel unhappy or unmotivated might insist to their primary care physician or behavioral health provider that they’re depressed, but the diagnosis of clinical depression is not a guessing game. Valid screening and precise diagnosis based on clinical criteria are required to ensure appropriate care that leads to optimal outcomes.

Depression is common

Even though popular culture might exaggerate, depression is in fact one of the most common mental health issues among Americans, according to the National Institutes of Health. Research suggests that depression is caused by a combination of genetic, biological, environmental, and psychological factors, and there is a long list of possible symptoms.

Data collected in Tridiuum ONE revealed 2.2 million assessments indicated moderate to severe depression out of a total of 6.3 million assessments studied. In 2021 alone, our analysis shows 246,922 unique patients indicating moderate to severe depression for data through August 4, and we estimate that number to rise to about 423,200 by year’s end.

That means among patients who were assessed by a provider for a behavioral health concern with Tridiuum ONE, 34 percent met the clinical criteria for moderate to severe depression. The percentage of assessments that indicate moderate to severe depression at intake tends to hover around the 50 percent line, according to Tridiuum data from the last 3.5 years.

Women and adults age 30-59 are the largest groups among intake assessments with depression results. In 2020 and in 2021, more than 70 percent of the individuals with assessments indicating moderate to severe depression were women. Likewise, adults age 30-59 have been the largest patient demographic consistently year over year, comprising 45.6 percent of those with depression results this year.

 Gender of Patients With Moderate to Severe Depression

 Age of Patients With Moderate to Severe Depression

Across the country, depression seemed to rise in the context of the COVID era that brought with it near universal fear and uncertainty. The National Center for Health Statistics is currently studying anxiety and depression symptoms to compare them to prepandemic symptom occurrence. Researchers are using a modified version of the two-item Patient Health Questionnaire (PHQ-2) and the two-item Generalized Anxiety Disorder (GAD-2) scale. Early results in the first phases of the study indicate depression symptoms in more than 20 percent of adults consistently since May 2020, compared to just 6.5 percent in 2019.

According to a report published Oct. 5 by the Centers for Disease Control and Prevention, national rates of anxiety and depression declined during the first half of 2021 but remain elevated when compared to pre-pandemic levels. The authors note that predicting and planning for fluctuations in demand for behavioral health services is difficult, However, real-time monitoring of symptoms can provide important information for responding to surges in the demand during national emergencies.

Potential new risk factors for depression

Research continues to investigate a variety of new potential risk factors for and correlations to depression. That’s why it’s important for providers to screen patients regularly. Below are just a few examples.

Prenatal depression: A study published in September in the British Journal of Psychiatry found children born to mothers who are depressed during and after pregnancy are more likely to develop depressive symptoms themselves through age 24.

Insulin resistance: A new study in The American Journal of Psychiatry found that people with insulin resistance had a higher risk of developing depression than those who did not. The authors note that there is accumulating biological evidence linking insulin resistance and depressive disorders.

Second-hand depression: Recent research from the Tokyo University of Science sought to understand the pathophysiology of depression in animal studies. It found that “second-hand” or vicarious psychological stress can lead to depression in mice.

Most clinicians know the common connections between depression and chronic disease, for example, as well as the co-occurring depression that’s typical with other behavioral health diagnoses, including substance use disorder. Similarly, clinicians typically consider treatment options when a patient expresses concern about feeling blue, losing interest in favorite activities, sleep disturbances, and the like.

Tracking progress with validated tools

After screening and accurate diagnosis with clinical criteria, the clinician’s next step is to quantify treatment response and patient progress with regular assessments. By knowing how a patient is doing on an ongoing basis throughout the continuum, care teams can optimize approaches to match where the patient is at during any point in the treatment journey.

When delivered automatically in a digital environment, integrated assessment tools can help providers save time. The patient knows when to fill out the assessment, and the data becomes available to the provider for in-person or virtual care encounters. Together, provider and patient can review progress, keeping the patient engaged in care through shared decision-making.

Digital depression assessments should be evaluated with an advanced analytics engine to rapidly identify emerging self-harm and suicide risks, coupled with care team alerts that should be delivered in real-time for immediate follow-up. At the enterprise level, analytics should be able to assign risk scores that support value-based care and distill information to support population health initiatives.

Knowing that depression is noted in 10.6 percent of medical visits, clinicians must not only identify patients who need care, they must also track the progress of care to ensure optimal outcomes and enhance patient engagement in treatment. Addressing this prevalent behavioral health concern will lead to improved whole-person health.