Screening and Treatment of Depression in the Community

• Rates of recognition of minor and major depression as reported by primary care physicians
  
• HAMD-17 scores and Beck's Depression Inventory (BDI) at 3 and 6 month follow up:
  
• change in HAMD-17 and BDI from baseline
  
• Remission at 6 months follow up is defined as HAMD-17 score <= 7
  
• Response to treatment at 6 months follow up is defined as a 50% reduction in HAMD-17 score
  
• CGI score at 6 month follow up
  

• Rates of physician and patient self-report of service utilization at 6 month follow up
  
• Improvement in follow-up SF-12 scores from baseline
  
• Caregiver burden at 6 month follow-up
  
• Patient satisfaction with care at 6 month follow up
  
• Physician feedback at 6 month follow up
  

Depression is a highly prevalent, clinically under-recognized and under-treated medical disorder world wide. In Singapore, 17% of the adult population experience recent psychiatric disturbances, yet only 6% use the services of any health professional. General practitioners are the most commonly preferred caregiver, and actually used by 41.1% of those who sought help. At the same time, suicide rates especially among the elderly remain at very high levels compared to other countries in the world.

In recent decades, screening questionnaires have been developed and validated that are suitable for the initial detection of depression in the primary care setting. Previous research have shown that screening for depression do not result in increased recognition rates of mental disorders unless positive cases are selectively fed back to primary care physicians. They also do not translate into increased rates of interventional activities such as initiation of therapy and referral to mental health specialists. Neither dose primary care physician education or clinical practice guidelines result in any improved outcomes for the patients unless these are accompanied by more sophisticated strategies in the organization and delivery of care, such as structured, collaborative, multidisciplinary care together with quality improvement processes.

More empirical data are therefore needed to establish whether screening for psychiatric disorders will enhance the recognition of clinical disorder, leading to better patient outcomes.