Challenges and implications of routine depression screening for depression in chronic disease and multimorbidity: a cross sectional study

Depression screening in chronic disease is advocated but its impact on routine practice is uncertain. We examine the effects of a programme of incentivised depression screening in chronic disease within a UK primary care setting. Cross sectional analysis of anonymised, routinely collected data (2008...

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Published in:PloS one 2013-09, Vol.8 (9), p.e74610-e74610
Main Authors: Jani, Bhautesh Dinesh, Purves, David, Barry, Sarah, Cavanagh, Jonathan, McLean, Gary, Mair, Frances S
Format: Article
Language:English
Subjects:
Activities of daily living
Adolescent
Adult
Aged
Aged, 80 and over
Aging - pathology
Analysis
Antidepressants
Antidepressive Agents - therapeutic use
Anxiety
Cardiovascular disease
Cardiovascular diseases
Chronic Disease
Chronic diseases
Chronic illnesses
Clinical outcomes
Comorbidity
Coronary artery disease
Coronary heart disease
Cross-Sectional Studies
Demography
Depression (Mood disorder)
Depression - diagnosis
Depression - drug therapy
Depression - epidemiology
Diabetes
Diabetes mellitus
Ethics
Family medicine
Female
Females
Health care
Health screening
Heart diseases
Humans
Male
Mass Screening
Medical diagnosis
Medical research
Medical screening
Medical treatment
Mental depression
Mental health
Middle Aged
Multimorbidity
Patient compliance
Patients
Pay for performance
Population
Practice Patterns, Physicians
Primary care
Regression Analysis
Stroke
Studies
Time Factors
Tricyclic antidepressants
United Kingdom - epidemiology
Young Adult
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creator Jani, Bhautesh Dinesh
Purves, David
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Mair, Frances S
description Depression screening in chronic disease is advocated but its impact on routine practice is uncertain. We examine the effects of a programme of incentivised depression screening in chronic disease within a UK primary care setting. Cross sectional analysis of anonymised, routinely collected data (2008-9) from family practices in Scotland serving a population of circa 1.8 million. Primary care registered patients with at least one of three chronic diseases, coronary heart disease, diabetes and stroke, underwent incentivised depression screening using the Hospital Anxiety and Depression Score (HADS). 125143 patients were identified with at least one chronic disease. 10670 (8.5%) were under treatment for depression and exempt from screening. Of remaining, HADS were recorded for 35537 (31.1%) patients. 7080 (19.9% of screened) had raised HADS (≥8); majority had indications of mild depression with HADS between 8 and 10. Over 6 months, 572 (8%) of those with raised HADS (≥8) were initiated on antidepressants, while 696 (2.4%) patients with normal HADS (
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We examine the effects of a programme of incentivised depression screening in chronic disease within a UK primary care setting. Cross sectional analysis of anonymised, routinely collected data (2008-9) from family practices in Scotland serving a population of circa 1.8 million. Primary care registered patients with at least one of three chronic diseases, coronary heart disease, diabetes and stroke, underwent incentivised depression screening using the Hospital Anxiety and Depression Score (HADS). 125143 patients were identified with at least one chronic disease. 10670 (8.5%) were under treatment for depression and exempt from screening. Of remaining, HADS were recorded for 35537 (31.1%) patients. 7080 (19.9% of screened) had raised HADS (≥8); majority had indications of mild depression with HADS between 8 and 10. 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We examine the effects of a programme of incentivised depression screening in chronic disease within a UK primary care setting. Cross sectional analysis of anonymised, routinely collected data (2008-9) from family practices in Scotland serving a population of circa 1.8 million. Primary care registered patients with at least one of three chronic diseases, coronary heart disease, diabetes and stroke, underwent incentivised depression screening using the Hospital Anxiety and Depression Score (HADS). 125143 patients were identified with at least one chronic disease. 10670 (8.5%) were under treatment for depression and exempt from screening. Of remaining, HADS were recorded for 35537 (31.1%) patients. 7080 (19.9% of screened) had raised HADS (≥8); majority had indications of mild depression with HADS between 8 and 10. Over 6 months, 572 (8%) of those with raised HADS (≥8) were initiated on antidepressants, while 696 (2.4%) patients with normal HADS (&lt;8) were also initiated on antidepressants (relative risk of antidepressant initiation with raised HADS 3.3 (CI 2.97-3.67), p value &lt;0.0001). Of those with multimorbidity who were screened, 24.3% had raised HADS (≥8). A raised HADS was more likely in females, socioeconomically deprived, multimorbid or younger (18-44) individuals. Females and 45-64 years old were more likely to receive antidepressants. retrospective study of routinely collected data. Despite incentivisation, only a minority of patients underwent depression screening, suggesting that systematic depression screening in chronic disease can be difficult to achieve in routine practice. Targeting those at greatest risk such as the multimorbid or using simpler screening methods may be more effective. 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subjects Activities of daily living
Adolescent
Adult
Aged
Aged, 80 and over
Aging - pathology
Analysis
Antidepressants
Antidepressive Agents - therapeutic use
Anxiety
Cardiovascular disease
Cardiovascular diseases
Chronic Disease
Chronic diseases
Chronic illnesses
Clinical outcomes
Comorbidity
Coronary artery disease
Coronary heart disease
Cross-Sectional Studies
Demography
Depression (Mood disorder)
Depression - diagnosis
Depression - drug therapy
Depression - epidemiology
Diabetes
Diabetes mellitus
Ethics
Family medicine
Female
Females
Health care
Health screening
Heart diseases
Humans
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Mass Screening
Medical diagnosis
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Mental depression
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Middle Aged
Multimorbidity
Patient compliance
Patients
Pay for performance
Population
Practice Patterns, Physicians
Primary care
Regression Analysis
Stroke
Studies
Time Factors
Tricyclic antidepressants
United Kingdom - epidemiology
Young Adult
title Challenges and implications of routine depression screening for depression in chronic disease and multimorbidity: a cross sectional study
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