Major depressive disorder is common. Estimates suggest about 18 million
adults, aged 18 or older, experienced a major depressive episode in
2018.1 While depression is associated with increased morbidity and
mortality, as well as diminished quality of life, it is estimated that only 65
percent of adults with depression receive treatment.1,2 Depression
is also a risk factor for suicide, the tenth leading cause of death in the
United States, and it is estimated that almost half of adults who committed
suicide had contact with a primary care provider in the month before their
death.2,3
Regular patient screening supports the identification and diagnosis of
depression, ensuring appropriate treatment and follow-up care. However, some
patients may not admit to or mention concerns about depressed mood, cognition
changes, or physical symptoms. As a result, it is important to consistently
assess patient risk factors and presenting symptoms.
Depression risk factors and symptoms
Multiple risk factors could contribute to a diagnosis of depression. The
following are risk factors to consider:
- presence of a serious chronic illness;
- biochemical changes;
- genetic factors;
- hormonal changes due to a recent pregnancy;
- social factors.
Depression can follow a recently diagnosed condition, may be triggered by
certain medications, or can be related to substance abuse. People with
co-occurring serious chronic medical illnesses and depression tend to have more
severe symptoms of both illnesses, requiring additional treatment and care, and
incurring added medical costs.4 Depression may follow child birth
and is associated with adverse maternal and infant outcomes. It is estimated
that 12 percent of women in the U.S. will experience postpartum depression;
some states report this rate may be as high as 20 percent.5
Patients experiencing depression may have chief complaints of non-specific
symptoms such as:
- changes in appetite;
- lack of energy;
- sleep disturbances;
- general aches and pains;
- headaches;
- menstrual symptoms;
- digestive problems or abdominal pain;
- sexual dysfunction.2
When patients present with non-specific symptoms, it is common to consider
medical conditions (e.g., fatigue and weight changes can be associated symptoms
of thyroid disease or anemia).2 It may be important to consider
depression as a differential diagnosis and to further discuss the presence of
other symptoms, including:
- depressed mood, sadness, or excessive crying;
- loss of interest or pleasure in hobbies or activities;
- impairments in functioning at home, work, or socially;
- changes to weight or appetite;
- insomnia or hypersomnia;
- restlessness or slowed body movements;
- fatigue;
- feelings of worthlessness or guilt;
- slowed thinking, diminished concentration, or indecisiveness;
- thoughts of death;
- acute suicidality or psychotic symptoms.
Screening tools and other resources
Risk reduction strategies include regular use of a depression screening tool
for your general adult population, including pregnant and postpartum patients.
Magellan Healthcare, Inc. (Magellan) provides a Behavioral
Health Toolkit for Medical Providers for more information about
identifying and treating depression, including access to screening tools,
clinical guidelines, and patient resources.
Referral to a behavioral health provider is recommended for complex cases,
including patients with bipolar depression, acute suicidality, psychosis, or
pregnancy. If you refer your patient to a behavioral health provider, regular
communication and coordination will help ensure an accurate diagnosis,
effective treatment, and appropriate follow-up care. For most of your
Independence patients, Magellan administers behavioral health benefits. Call
the number on the back of the member’s benefits card to arrange a
referral.
Other useful resources include:
- Suicide Prevention Resource
Center: This service provides information on state prevention plans,
resources, and programs as well as trainings and materials for
professionals.
- Zero Suicide:
This framework provides functional tools and resources for system-wide
transformation toward safer suicide care in health and behavioral
healthcare.
- National Alliance on
Mental Illness Philadelphia: This service provides information and support
to people with mental illness as well as their families, caregivers, and
friends.
- SAMHSA’s National Helpline: The Substance Abuse and
Mental Health Services Administration (SAMHSA) helpline provides 24-hour,
confidential treatment referral and information about mental and/or substance
use disorders, prevention, and recovery.
- 1-800-662-HELP (1-800-662-4357) (TTY:
1-800-487-4889)
- Suicide
Prevention Lifeline: This is a 24-hour, confidential, suicide prevention
hotline available to anyone in suicidal crisis or emotional distress.
- 1-800-273-TALK (1-800-273-8255) (TTY:
1-800-799-4889)
Be sure to discuss appropriate resources with your patients. Please
encourage the member to call the number on the back of their ID card if they
need mental health services.
1SAMHSA.
“Key substance use and mental health indicators in the United States:
Results from the 2018 National Survey on Drug Use and Health.” HHS
Publication No. PEP19?5068, NSDUH Series H?54. 2019. Available from:
https://www.samhsa.gov/data/report/2018-nsduh-annual-national-report
2Ferenchick,
E. K., Ramanuj, P., & Pincus, H. A. “Depression in primary care: part
1–screening and diagnosis." British Medical Journal; 365, l794. 2019. Available from:
https://www.bmj.com/content/bmj/365/bmj.l794.full.pdf
3Centers for Disease Control and
Prevention, National Center for Health Statistics. “Health, United
States, 2017: With special feature on mortality.” Hyattsville, MD. 2018.
Available from: https://www.cdc.gov/nchs/data/hus/hus17.pdf
4National
Institute of Mental Health. "Chronic Illness & Mental Health." NIH
Publication No. 15-MH-8015. Available
from:
https://www.nimh.nih.gov/health/publications/chronic-illness-mental-health/index
.shtml
5Ko, J. Y.,
Rockhill, K. M., Tong, V. T., Morrow, B., & Farr, S. L. “Trends in
Postpartum Depressive Symptoms – 27 States, 2004, 2008, and 2012."
Morbidity and Mortality Weekly Report; 66, 6. 2017. Available from:
https://www.cdc.gov/mmwr/volumes/66/wr/pdfs/mm6606a1.pdf
Magellan Healthcare, Inc., an independent company,
manages mental health and substance abuse benefits for most Independence
members.