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October is National Depression and Mental Health Screening Month
Depression is both common and highly treatable, and annual screening is a simple way to identify patients who may benefit from further conversation and potential intervention.
The PHQ-9 is a 9-item assessment of the frequency of anhedonia and depressed mood over the last 2 weeks and can be administered by a staff member or self-administered by the patient.
What to do with positive screens?
We understand that timely access to behavioral and mental health care services can be challenging and, as a result, treatment responsibility falls on non-psychiatric providers.
This is the main reason we began our Mind Matters behavioral health learning collaborative. Recordings and slide decks from all 22 of our previous meetings are available on our website. We've covered topics ranging from depression screening and treatment to substance use disorders, behavioral interventions for insomnia, and more.
Psychotherapy can be highly effective for mild to moderate depression and/or anxiety, and in conjunction with pharmacological treatment for more severe cases. Payers are required to cover treatment for behavioral health conditions without restriction on session frequency or duration.
What if the patient endorses any suicidality?
The last question on the PHQ-9 asks the patient if they've had any thoughts of hurting themselves or being better off dead. How should you proceed if they say yes?
Our Provider's Guide to Suicide Risk Assessment offers advice and strategies for initiating the conversation, documentation, and next steps. Last month's Suicide Prevention Month special issue of the Behavioral Health Bulletin goes into more detail about resources to help you compassionately address suicidality.
Remember that a positive response to item 9 does not necessarily indicate imminent danger. Of all patients who admit to suicidal ideation on the PHQ-9, only approximately 1 in 200 will actually make an attempt. Most suicidal people do not actively want to die, but rather see no other solution; this underscores why empathic and non-judgmental conversations are crucial.
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