Anyone who has ever been diagnosed with depression or knows someone who has is aware of the sometimes devastating impact this condition can have on the individual and the people they care about. Most notably, these negative impacts are augmented when a person’s depression goes undertreated or undiagnosed. As part of widespread efforts to combat this issue, National Depression Screening Day was pioneered in 1990 by a mental health advocacy organization called Screening for Mental Health as the nation’s first voluntary mental health screening initiative. An integral component of Mental Illness Week, National Depression Screening Day is a campaign that hosts depression screening events to promote increased awareness of mental health resources and screening tools available to everyone and has since been embraced by various community-based organizations, universities, and even military bases.
The importance of initiatives like this cannot be overstated, as at least half of the population will be diagnosed with a mental illness at some point in their lifetimes, according to the CDC. Specifically, depression, though underdiagnosed, is thought to be the leading cause of disability in the U.S. The consequences of this dearth in screening and, thus, dearth in diagnosis of depression is an increase in its severity and, thus, disabling effects. In fact, people with serious, undiagnosed mental illnesses can live as up to 25 years less than their healthy or treated peers. When depression subsequently becomes so severe, it can lead to hospitalization and currently ties with anxiety as the third most common cause of hospitalization for adults aged 18-44. Ultimately, untreated depression is linked to decreased quality of life, increased economic burden, and increased mortality.
Why do so many people with depression go undiagnosed? The truth is that depression is often difficult to detect because of the range of symptoms people experience and individual reluctances to acknowledge depression. Screening is critical because unlike some rare and life threatening conditions, depression can be effectively treated, especially when treatment is started early in a person’s course.
The most common screening tools used in the primary care setting are the Patient Health Questionnaires (PHQs) 2 and 9. The PHQ-2 is also known as the “Two-Question Screen” and comprises the 2 initial questions on the PHQ-9: 1) During the last month, have you often been bothered by feeling down, depressed, or hopeless?; 2) During the last month, have you often been bothered by having little interest or pleasure in doing things? A score of greater than or equal to 3 indicates possible clinical depression. This screening tool has an 83% efficacy in detecting depression (also known as sensitivity) and a 90 percent efficacy in diagnosing it (also known as specificity). The advantage of this tool is that it is brief and easy to administer verbally. The PHQ-9, which, as you have probably guessed, consists of 9 questions, is 88% sensitive and 88% specific and is most useful for monitoring a patient’s response to treatment. It is scored on a scale of 0 to 27, with a score equaling or greater than 10 indicating possible depressive disorder. Uniquely, it includes a question to assess whether a person’s symptoms are impairing their functioning, which is a key criterion for establishing a DSM-based diagnosis.
As with most screening questionnaires, the aforementioned ones are not alone sufficient to diagnose a person’s depression. Positive screening results should always be followed up with formal diagnostic assessments by mental health professionals either through referrals from primary care providers (PCPs).
No one deserves to suffer in silence, and we do not have to wait until campaigns like National Depression Screening Day to get proper assessments and care. Talk to a local PCP or fill out an anonymous screening tool here to begin the healing process for you or your loved ones.