QUEBEC CITY — Brief depression screening during well-child visits can detect parents at risk and requires little extra time, Dr. Ardis L. Olson reported at the annual meeting of the North American Primary Care Research Group.
The U.S. Preventive Services Task Force recommends that all adults have brief depression screening, and pediatricians and family physicians may be the health professionals seen most by parents. Detecting parental mental health issues is an important way to lessen the impact of such issues on children.
In these cases, the role of the child's physician is not to diagnose depression, but to identify parents at risk for depression, encourage them to seek help, and refer them to available resources, said Dr. Olson of the departments of pediatrics and community and family medicine at Dartmouth Medical School, Lebanon, N.H.
As part of Dartmouth's parental well-being project, Dr. Olson and colleagues prepared practitioners to screen parents for depression with a two-question screener given during well-child visits over 6 months in six community pediatric practices in New Hampshire and Vermont.
Screening results were discussed with the parents, and a centralized telephone referral service was provided for those who screened positive.
The two questions were, “Over the past 2 weeks, have you felt down, depressed, or hopeless?” and “Over the past 2 weeks, have you felt little interest or pleasure in doing things?” If they answered yes to either question, they were then asked to identify if it had been for several days, more than half the days, or nearly every day.
Providers and staff also completed follow-up surveys during three 1-week periods.
The two-question screeners were collected during 7,990 of 16,716 well-child visits (48%). After removing screeners with incomplete data, a total of 6,446 were analyzed.
One in seven parents revealed mood or anhedonia symptoms (881 of 5,772 mothers and 88 of 674 fathers).
Of the parents screened, 1 in 20 was at risk for major depression (285 mothers and 34 fathers).
The screening also generated discussion with mothers with fewer symptoms, she said. One in five of these mothers (31 of 152) admitted possible depression and were willing to take action to treat it.
The discussion with parents about their screening results took less than 3 minutes in 90% of cases and more than 10 minutes in 1.4%.
Nurse practitioners were more likely than were physicians (46% vs. 37%, respectively) to refer screen-positive parents to their primary care or mental health providers.
Although physicians and nurse practitioners referred 21% of screen-positive parents to the support line, only 20 parents called the 800 number in the first 12 weeks of the study. Overall, 5% of referred parents received some telephone counselor assistance.
The findings demonstrate that community practices can implement routine, brief parental depression screening when administrative and leadership support is in place, Dr. Olson said. The staff of the six practices that participated in the study stressed that reduced staffing affected their ability to routinely screen.