Discrepancy Between Primary Care Screening for Alcohol Use and Screening for Depression

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The PHQ-9, which the US Preventive Services Task Force recommends for depression screening in primary care, was administered to only 2.4% of patients.
The PHQ-9, which the US Preventive Services Task Force recommends for depression screening in primary care, was administered to only 2.4% of patients.

Very few primary care patients who are screened for hazardous alcohol use are also administered a standardized instrument to screen for depression, with rates of depression screening lower among nonwhites and patients who are more severely medically ill, according to a study published in the Journal of the American Board of Family Medicine.

A group of investigators analyzed the frequency of depression screening according to the severity of alcohol use among primary care patients to determine if hazardous alcohol consumption is associated with significant depressive symptoms and if primary care patients are being screened properly.

Using cross-sectional information from 2,894,906 primary care patients (≥18 years of age), the researchers recorded patient alcohol use within the past 90 days, noting the typical number of drinking days per week and the typical number of drinks per day. They also noted whether the Patient Health Questionnaire 9 (PHQ-9), a standardized instrument recommended by the US Preventive Services Task Force for depression screening in primary care, was administered. If so, the investigators further observed if patients' total scores met the criteria for significant depression, which was defined as a total score of 10 or higher.

Measured outcomes also included symptom severity, patient demographics, and the prevalence of selected psychiatric diagnoses.

Within 30 days of the first screening for alcohol use, the PHQ-9 was administered to only 2.4% (n = 68,686) of the screened patients. The PHQ-9 was more likely to be administered to patients with the following characteristics: female sex (65.5%), age 18 to 39 years (47%), white race/ethnicity (56.8%), and abstinence from alcohol use (66.2%); of those who received PHQ-9 screening (n = 32,390), 47.2% endorsed significant depressive symptoms in the past 2 weeks.

“Only a small fraction of patients in this cohort were screened for depression,” the authors wrote. “Nonwhite patients and those with higher comorbidity burden were more likely to report depression but less likely to be screened. These discrepancies between depression-screening rates and significant depressive symptoms suggest that screening for depression should be enhanced in these at-risk groups,” the authors concluded.

Reference

Hirschtritt ME, Kline-Simon AH, Kroenke K, Sterling SA. Depression screening rates and symptom severity by alcohol use among primary care adult patients. J Am Board Fam Med. 2018;31:724-732.

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