Challenges and Implications of Routine Depression Screening for Depression in Chronic Disease and Multimorbidity: A Cross Sectional Study

Depression screening in chronic disease is advocated but its impact on routine practice is uncertain. We examine the effects of a programme of incentivised depression screening in chronic disease within a UK primary care setting.

Jani BD, Purves D, Barry S, Cavanagh J, McLean G, Mair FS. Challenges and Implications of Routine Depression Screening for Depression in Chronic Disease and Multimorbidity: A Cross Sectional Study. PLoS ONE. 2013 Sep 13;8(9):e74610.

Examines the impact of routine depression screening, using the Hospital Anxiety and Depression Scale (HADS), and its relationship with multimorbidity and chronic disease management. In our study based on more than 125000 patients with chronic disease, the findings highlight the difficulties in implementing depression screening universally in primary care, despite incentivisation. Younger patients and those from deprived socio-economic background were more likely to have a positive result, when screened for depression symptoms. Importantly, depression screening did lead to an increase in the rate of anti-depressant prescribing in patients with chronic disease, which has significant resource implications.

In this study, depression screening was more often undertaken in patients with multimorbidity when compared to those with a single disease. Patients with multimorbidity had a greater chance of having a raised HADS score on depression screening, which resonates with the emerging evidence in this area. The crucial question will be to investigate the effect of depression screening in patients with chronic disease and multimorbidity on clinical outcomes, if any. The next phase of our project aims to address this question.