Depression Screening Is Not Enough
Authors: Kurt Kroenke
Journal: Annals of Internal Medicine (2001)

Editorials6 March 2001Depression Screening Is Not EnoughKurt Kroenke, MDKurt Kroenke, MDDr. Kroenke: Regenstrief Institute for Health Care; Indianapolis, IN 46202Author, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-134-5-200103060-00014 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Not enough" does not mean "not at all." The individual and societal burden of depression is enormous in terms of economic costs (over $40 billion annually in the United States alone); disability days; and pervasive effects on physical, mental, and social well-being (1-3). This burden, coupled with the eminent treatability of depression, compels us to action (4, 5). The first action must be recognition of the depressed patient, without which amelioration is impossible. The second action is treating the patient in whom depression has been identified. Although screening can enhance both recognition and initiation of treatment (6), improvement in depression ...References1. Spitzer RL, Kroenke K, Linzer M, Hahn SR, Williams JB, deGruy FV, et al. . Health-related quality of life in primary care patients with mental disorders. Results from the PRIME-MD 1000 Study. JAMA. 1995;274:1511-7. [PMID: 0007474219] CrossrefMedlineGoogle Scholar2. Ormel J, VonKorff M, Ustun TB, Pini S, Korten A, Oldehinkel T. Common mental disorders and disability across cultures. Results from the WHO Collaborative Study on Psychological Problems in General Health Care. JAMA. 1994;272:1741-8. [PMID: 0007966922] CrossrefMedlineGoogle Scholar3. Greenberg PE, Stiglin LE, Finkelstein SN, Berndt ER. The economic burden of depression in 1990. J Clin Psychiatry. 1993;54:405-18. [PMID: 0008270583] MedlineGoogle Scholar4. Simon GE. Can depression be managed appropriately in primary care? J Clin Psychiatry. 1998;59 Suppl 2 3-8. [PMID: 0009559753] MedlineGoogle Scholar5. Rubenstein LV, Jackson-Triche M, Unutzer J, Miranda J, Minnium K, Pearson ML, et al. . Evidence-based care for depression in managed primary care practices. Health Aff Millwood. 1999;18:89-105. [PMID: 0010495595] CrossrefMedlineGoogle Scholar6. Kroenke K, Taylor-Vaisey A, Dietrich AJ, Oxman TE. Interventions to improve provider diagnosis and treatment of mental disorders in primary care. A critical review of the literature. Psychosomatics. 2000;41:39-52. [PMID: 0010665267] CrossrefMedlineGoogle Scholar7. Mulrow CD, Williams JW, Gerety MB, Ramirez G, Montiel OM, Kerber C. Case-finding instruments for depression in primary care settings. Ann Intern Med. 1995;122:913-21. [PMID: 0007755226] LinkGoogle Scholar8. Kroenke K, Spitzer RL, Williams JB, Linzer M, Hahn SR, deGruy FV, et al. . Physical symptoms in primary care. Predictors of psychiatric disorders and functional impairment. Arch Fam Med. 1994;3:774-9. [PMID: 0007987511] CrossrefMedlineGoogle Scholar9. Simon GE, VonKorff M, Piccinelli M, Fullerton C, Ormel J. An international study of the relation between somatic symptoms and depression. N Engl J Med. 1999;341:1329-35. [PMID: 0010536124] CrossrefMedlineGoogle Scholar10. Hahn SR, Kroenke K, Spitzer RL, Brody D, Williams JB, Linzer M, et al. . The difficult patient: prevalence, psychopathology, and functional impairment. J Gen Intern Med. 1996;11:1-8. [PMID: 0008691281] CrossrefMedlineGoogle Scholar11. Williams JW, Mulrow CD, Kroenke K, Dhanda R, Badgett RG, Omori D, et al. . Case-finding for depression in primary care: a randomized trial. Am J Med. 1999;106:36-43. [PMID: 0010320115] CrossrefMedlineGoogle Scholar12. Whooley MA, Avins AL, Miranda J, Browner WS. Case-finding instruments for depression. Two questions are as good as many. J Gen Intern Med. 1997;12:439-45. [PMID: 0009229283] CrossrefMedlineGoogle Scholar13. Simon GE, Goldberg D, Tiemens BG, Ustun TB. Outcomes of recognized and unrecognized depression in an international primary care study. Gen Hosp Psychiatry. 1999;21:97-105. [PMID: 0010228889] CrossrefMedlineGoogle Scholar14. Rost K, Smith R, Matthews DB, Guise B. The deliberate misdiagnosis of major depression in primary care. Arch Fam Med. 1994;3:333-7. [PMID: 0008012621] CrossrefMedlineGoogle Scholar15. Valenstein M, Vijan S, Zeber JE, Boehm K, Buttar A. The cost–utility of screening for depression in primary care. Ann Intern Med. 2001;134:345-60. [PMID: 0011242495] LinkGoogle Scholar16. Wells KB, Stewart A, Hays RD, Burnam MA, Rogers W, Daniels M, et al. . The functioning and well-being of depressed patients. Results from the Medical Outcomes Study. JAMA. 1989;262:914-9. [PMID: 0002754791] CrossrefMedlineGoogle Scholar17. Unutzer J, Patrick DL, Diehr P, Simon G, Grembowski D, Katon W. Quality adjusted life years in older adults with depressive symptoms and chronic medical disorders. Int Psychogeriatr. 2000;12:15-33. [PMID: 0010798451] CrossrefMedlineGoogle Scholar18. Wells KB, Sturm R, Sherbourne CD, Meredith LS. Caring for Depression. Cambridge, MA: Harvard Univ Pr; 1996. Google Scholar19. Dietrich AJ. The telephone as a new weapon in the battle against depression. Eff Clin Pract. 2000;4:191-3. Google Scholar20. Keller MB, McCullough JP, Klein DN, Arnow B, Dunner DL, Gelenberg AJ, et al. . A comparison of nefazodone, the cognitive behavioral-analysis system of psychotherapy, and their combination for the treatment of chronic depression. N Engl J Med. 2000;342:1462-70. [PMID: 0010816183] CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: Dr. Kroenke: Regenstrief Institute for Health Care; Indianapolis, IN 46202Corresponding Author: Kurt Kroenke, MD, Regenstrief Institute for Health Care, RG-6, 1050 Wishard Boulevard, Indianapolis, IN 46202; e-mail, kkroe[email protected]org. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoThe Cost–Utility of Screening for Depression in Primary Care Marcia Valenstein , Sandeep Vijan , John E. Zeber , Kathryn Boehm , and Amna Buttar Should We Screen for Depression in Primary Care? Marcia Valenstein , Sandeep Vijan , and John Zeber Metrics Cited ByHealthcare utilization and out-of-pocket expenditures associated with depression in adults: a cross-sectional analysis in NepalTelehealth and Women's Perinatal Mental HealthPsychometric Assessment of Tinnitus Patients Within Clinical Practice SettingsHelp-Seeking Behavior for Depression in Japanese SchoolteachersIntegrated management of major depression for people with cancerPersonality is of central concern to understand health: towards a theoretical model for health psychologyCare for common mental health problems: applying evidence beyond RCTsTreating postnatal depressive symptoms in primary care: a randomised controlled trial of GP management, with and without adjunctive counsellingThe 'help' question doesn't help when screening for major depression: external validation of the three-question screening test for primary care patients managed for physical complaintsDepression and Postpartum DisordersAn Ultra-Brief Screening Scale for Anxiety and Depression: The PHQ–4Screening for postnatal depression: barriers to successChildren's Mental Health Emergencies-Part 1One question as a screening instrument for depression in people with multiple sclerosisDetection of major depression in Ugandan primary health care settings using simple questions from a subjective well-being (SWB) subscalePolycystic Ovary Syndrome and Mental Health: A ReviewValidez de la escala breve de Zung para tamizaje del episodio depresivo mayor en la población general de Bucaramanga, ColombiaFeelings of being disabled as a risk factor for mortality up to 8 years after acute myocardial infarctionThe Evolution of Behavioral Primary Care.Physicians' Constructions of Depression: Inside/Outside the Boundaries of MedicalizationUse of brief depression screening tools in primary care: consideration of heterogeneity in performance in different patient groupsEffectiveness of disease management programmes for recognition, diagnosis and treatment of depression in primary care: A reviewThe Patient Health Questionnaire-2Patients presenting with somatic complaints: epidemiology, psychiatric co-morbidity and managementConsiderations in the Management of the Patient with Comorbid Depression and AnxietyImproving the Management of Depression in Primary CareShould We Screen for Depression in Primary Care?Marcia Valenstein, MD, MS, Sandeep Vijan, MD, MS, and John Zeber, MHAComorbid Depression is Associated With Increased Health Care Use and Expenditures in Individuals With Diabetes 6 March 2001Volume 134, Issue 5Page: 418-420KeywordsAsthmaCancer screeningCardiovascular disease riskCommunication in health careHealth careHealth care providersHeart failurePatientsPsychiatry and mental healthRacial and ethnic issues ePublished: 6 March 2001 Issue Published: 6 March 2001 CopyrightCopyright © 2001 by American College of Physicians. All Rights Reserved.PDF DownloadLoading ...