Key result
Routine depression screening in chronic illness is hindered by time constraints and insufficient mental health training.
Why the study?
Routinely conducting case finding for depression in patients with chronic illness in primary care appears to have little impact, and the implementation factors affecting its effectiveness are unclear.
Observational (n=90)
Yes
Routine screening for depression in primary care for patients with chronic illnesses like CHD may lead to under-detection due to mechanistic implementation and lack of provider confidence.
Raises caution for routine depression screening in chronic illness; leaves open effective strategies to overcome time and training barriers.
BACKGROUND: Routinely conducting case finding (also commonly referred to as screening) in patients with chronic illness for depression in primary care appears to have little impact. We explored the views and experiences of primary care nurses, doctors and managers to understand how the implementation of case finding/screening might impact on its effectiveness. METHODS: Two complementary qualitative focus group studies of primary care professionals including nurses, doctors and managers, in five primary care practices and five Community Health Partnerships, were conducted in Scotland. RESULTS: We identified several features of the way case finding/screening was implemented that may lead to systematic under-detection of depression. These included obstacles to incorporating case finding/screening into a clinical review consultation; a perception of replacing individualised care with mechanistic assessment, and a disconnection for nurses between management of physical and mental health. Far from being a standardised process that encouraged detection of depression, participants described case finding/screening as being conducted in a way which biased it towards negative responses, and for nurses, it was an uncomfortable task for which they lacked the necessary skills to provide immediate support to patients at the time of diagnosis. CONCLUSION: The introduction of case finding/screening for depression into routine chronic illness management is not straightforward. Routinized case finding/screening for depression can be implemented in ways that may be counterproductive to engagement (particularly by nurses), with the mental health needs of patients living with long term conditions. If case finding/screening or engagement with mental health problems is to be promoted, primary care nurses require more training to increase their confidence in raising and dealing with mental health issues and GPs and nurses need to work collectively to develop the relational work required to promote cognitive participation in case finding/screening.
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Maxwell et al. (2013) conducted an observational in Depression in diabetes or coronary heart disease (n=90). Routine case finding/screening for depression was evaluated on Views and experiences of implementing depression screening. Primary care professionals reported that routine screening for depression in patients with chronic illness was often implemented mechanistically and hindered by time constraints and nurses' lack of mental health training.
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