Outcomes of a Depression Screening and Postscreen Intervention Pilot Program in Specialty Clinics

The authors evaluated the feasibility of automated depression screening and a follow-up postscreening protocol. Patient Health Questionnaire-2 (PHQ-2) and PHQ-9 screeners were sent to 20 specialty clinics and administered to patients who were ages ≥18 years, had not completed a PHQ-2 or PHQ-9 within the past 9 months, had no psychiatric diagnosis within the past 2 years, and had no behavioral health appointment within the previous year or an upcoming behavioral health appointment. In a two-pronged approach, patients with scores indicating moderate or moderately severe depression but with no indication of possible suicidal ideation were offered behavioral health resources (first prong), or patients with scores indicating severe depression or with possible suicidal ideation were contacted via telephone and requested to schedule a behavioral health appointment (second prong). The PHQ-2 was offered to 21,674 patients, with 38.1% (N=8,247) completing the screening; 13.1% (N=1,084) of those with completed screens had a positive depression score. Of patients who completed the PHQ-9, 44.5% (N=650) were eligible for the first prong of the intervention and 31.1% (N=455) for the second prong. Depression screening completion rates differed significantly by multiple sociodemographic factors. Mean±SD lag times from screening completion to successful contact and from contact to appointment completion were 7±6 and 5±4 days, respectively. Automated depression screening with outreach based on depression severity is feasible and provides potentially efficient use of scarce resources. More research is needed on the mechanisms for automated screening and follow-up to examine factors such as patient engagement after a positive screening.