Special CME Issue - West Virginia State Medical Association

A Review of Depression Prevention in Primary Care
Karen Clark, MD, FACP
Assistant Clinical Director of WELLWVU Student Health,
WVU, Morgantown
Christine Weir, MBA
Depression Case Manager, WELLWVU Student Health,
WVU, Morgantown
Abstract
The treatment of depression in
primary care has become a pressing
clinical topic in recent years. Research
has detailed the chronic, common, and
costly nature of the disease. In an effort to
meet the proactive preventive challenge
of physicians, this review integrates
current research and suggestions for
practice across the spectrum of
preventive medicine. Patient education,
screening, and follow up care are among
the topics discussed with a special
consideration for the unique cultural,
environmental, and demographic
influences of West Virginia residents. The
overall objective of this review is to raise
awareness of depression and increase
access to mental health services within
primary care.
A Review of Depression
Prevention in Primary Care
The evaluation and management
of depression in primary care
has become a key clinical topic.
Research has provided convincing
evidence of the chronic, common,
and costly nature of the disease
among adolescents and adults.
Preventive methods can be used not
only to prevent the development of
depression, but can delay the onset
and minimize the consequences of
the disease. The following review
presents an integration of recent
research and suggestions for better
practice that target education,
screening, assessment, and
interventions across the spectrum of
preventive medicine. Considerations
of the unique environmental,
demographic, and cultural features of
West Virginia residents are included.
Nature of the Disease
There is fairly strong agreement
that depression is in fact a chronic
illness that is frequently recurrent
throughout the lifespan. Despite
this fact, research suggests that
few primary care patients being
treated for depression receive
continuation and maintenance
phase treatment. 1 To meet this
need, there have been an increasing
number of quality improvement
techniques and models for chronic
disease management that specifically
address depression management. 2
In addition to the chronic nature
of the disease, depression is also
exceedingly common. Telephone
interviews of West Virginia residents
(ages 18-64) found that nearly 1 in 3
persons (31%) reported symptoms
of depression within a week of
the interview. 3 This is relatively
high when compared with the
national prevalence of 10.3% within
a 12-month period. 4 Depression
represents a major cause of disability
in the US and worldwide. 5, 6 It
accounts for a large number of days
missed and lost productivity among
employees, who struggle to have
the energy to complete tasks and the
focus to sustain work. Furthermore,
depression frequently co-occurs
with other chronic disorders such
as diabetes, 7 myocardial infarction, 8
congestive heart failure, 9 chronic
fatigue syndrome, 10 HIV, 11 and
rheumatoid arthritis. 12 Depression
often becomes an added weight to
patients who are already suffering
the effects of other chronic diseases.
Depression is costly. A study
estimated that 5.6 hours per
week were lost from employees
with untreated depression,
compared with an average of 1.5
productive hours of work lost
from those without depression. 13
Depression was estimated to
cost employers $51.5 billion per
year in lost productivity. 14 On the
clinical side, depression creates a
financial burden of unnecessary
tests and medical workups in an
attempt to diagnose the patient’s
unexplained symptoms. Often, a
simple depression assessment is not
administered, which may have saved
the physician, patient, and system
valuable time, effort, and resources.
Emphasis on Primary Care
There is a high occurrence
of depression in primary care.
This incidence has been noted by
several researchers, 15,16,17 and is not
expected to decrease. Looking at
the percent of new antidepressant
prescriptions written by primary
care physicians in comparison
Objectives
The primary objective of this manuscript is to develop a comprehensive understanding of the needs of depression care in order to
meet the challenges of today’s primary care practice. Specifically, current education, screening, assessment, and interventions are
discussed. Consideration is also taken to the unique cultural, environmental, demographic influences of West Virginia. Overall, readers
will be more aware of the challenges of depression care with the consequences of not meeting this need within primary care.
64 West Virginia Medical Journal