Percentage of patients aged 12 years and older screened for clinical depression on the date of the encounter using an age appropriate standardized depression screening tool AND if positive, a follow-up plan is documented on the date of the positive screen.

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The World Health Organization (WHO), as seen in Pratt & Brody (2008), found that major depression was the leading cause of disability worldwide. Depression causes suffering, decreases quality of life, and causes impairment in social and occupational functioning. It is associated with increased health care costs as well as with higher rates of many chronic medical conditions. Studies have shown that a higher number of depression symptoms are associated with poor health and impaired functioning, whether or not the criteria for a diagnosis of major depression are met. Persons 40-59 years of age had higher rates of depression than any other age group. Persons 12-17, 18-39 and 60 years of age and older had similar rates of depression. Depression was more common in females than in males. Non-Hispanic Black persons had higher rates of depression than non-Hispanic White persons. In the 18-39 and 40-59 age groups, those with income below the federal poverty level had higher rates of depression than those with higher income. Among persons 12-17 and 60 years of age and older, rates of depression did not vary significantly by poverty status. 

Overall, approximately 80% of persons with depression reported some level of difficulty in functioning because of their depressive symptoms. In addition, 35% of males and 22% of females with depression reported that their depressive symptoms make it very or extremely difficult for them to work, get things done at home, or get along with other people. More than one-half of all persons with mild depressive symptoms also reported some difficulty in daily functioning attributable to their symptoms. 



15–20 percent of adults older than age 65 in the United States have experienced depression (Geriatric Mental Health Foundation, 2008). 7 million adults aged 65 years and older are affected by depression (Steinman, 2007). Chronically ill Medicare beneficiaries with accompanying depression have significantly higher health care costs than those with chronic diseases alone (Unutzer, 2009). People aged 65 years and older accounted for 16 percent of suicide deaths in 2004 (Centers for Disease Control and Prevention, 2007).



The negative outcomes associated with early onset depression, make it crucial to identify and treat depression in its early stages. As reported in Borner et al. (2010), a study conducted by the World Health Organization (WHO) reported that in North America, primary care and family physicians are likely to provide the first line of treatment for depressive disorders. Others consistently report a 10% prevalence rate of depression in primary care patients. But studies have shown that primary care physicians fail to recognize up to 50% of depressed patients, purportedly because of time constraints and a lack of brief, sensitive, easy-to administer psychiatric screening instruments. Coyle et al. (2003), suggested that the picture is more grim for adolescents, and that more than 70% of children and adolescents suffering from serious mood disorders, go unrecognized or inadequately treated.  Healthy People 2020 recommends routine screening for mental health problems as a part of primary care for both children and adults (U.S. Department of Health and Human Services, 2014).   



Major depressive disorder (MDD) is a debilitating condition that has been increasingly recognized among youth, particularly adolescents. The prevalence of current or recent depression among children is 3% and among adolescents is 6%. The lifetime prevalence of MDD among adolescents may be as high as 20%. Adolescent-onset MDD is associated with an increased risk of death by suicide, suicide attempts, and recurrence of major depression by young adulthood. MDD is also associated with early pregnancy, decreased school performance, and impaired work, social, and family functioning during young adulthood (Williams et al., 2009). Every fifth adolescent may have a history of depression by age 18. The increase in the onset of depression occurs around puberty. According to Zalsman et al. (2006), as reported in Borner et al. (2010), depression ranks among the most commonly reported mental health problems in adolescent girls. 



The economic burden of depression is substantial for individuals as well as society. Costs to an individual may include suffering, possible side effects from treatment, fees for mental health and medical visits and medications, time away from work and lost wages, transportation, and reduced quality of personal relationships. Costs to society may include loss of life, reduced productivity (because of both diminished capacity while at work and absenteeism from work), and increased costs of mental health and medical care. In 2000, the United States spent an estimated $83.1 billion in direct and indirect costs of depression (USPSTF, 2009).

Adolescent Recommendation (12-18 years):

The USPSTF recommends screening of adolescents (12-18 years of age), for major depressive disorder (MDD) when systems are in place to ensure accurate diagnosis, psychotherapy (cognitive-behavioral or interpersonal), and follow-up (AHRQ, 2010, p.141).



Clinicians and health care systems should try to consistently screen adolescents, ages 12-18,  for major depressive disorder, but only when systems are in place to ensure accurate diagnosis, careful selection of treatment, and close follow-up (ICSI, 2013, p. 16).



Adult Recommendation (18 years and older):

The USPSTF recommends screening adults for depression when staff-assisted depression care supports are in place to assure accurate diagnosis, effective treatment, and follow-up (AHRQ, 2010, p.136). 



A system that has embedded the elements of best practice and has capacity to effectively manage the volume, should consider routine screening of all patients based on the recommendations of the U.S. Preventive Services Task Force (ICSI, 2013, p. 7). Clinicians should use a standardized instrument to screen for depression if it is suspected, based on risk factors or presentation. Clinicians should assess and treat for depression in patients with some comorbidities. Clinicians should acknowledge the impact of culture and cultural differences on physician and mental health. Clinicians should screen and monitor depression in pregnant and post-partum women (ICSI, 2013, p. 4).

Higher score indicates better quality.

Pratt L.A, Brody DJ.(2008). Depression in the United States household population, 2005–2006. U.S. Department of Health and Human Services, Centers for Disease Control and Prevention National Center for Health Statistics. NCHS Data Brief No.7, 1-8.

Borner I, Braunstein JW, St. Victor, R, Pollack J (2010). Evaluation of a 2-question screening tool for detecting depression in adolescents in Primary Care. Clinical Pediatrics, 49, 947-995. doi: 10.1177/0009922810370203

Coyle J T, Pine D.S, Charney D S, Lewis L, Nemeroff C B, Carlson G A, Joshi P T (2003). Depression and bipolar support alliance consensus development panel. Depression and bipolar support alliance consensus statement on the unmet needs in diagnosis and treatment of mood disorders in children and adolescents. Journal of the American Academy of Child and Adolescent Psychiatry, 42, 1494-1503.

U.S. Department of Health and Human Services (2014). Healthy People 2020. Washington, DC: U.S. Department of Health and Human Services. Retrieved from: http://www.healthypeople.gov/2020/topicsobjectives2020/objectiveslist.aspx?topicId=28

Williams SB. O'Connor EA, Eder M, Whitlock EP (2009). Screening for Child and Adolescent Depression in Primary Care Setting: A Systematic Evidence Review for the US Preventive Services Task Force. Pediatrics, 123, e716-e735. doi:10.1542/peds.2008-2415

Zalsman G, Brent DA & Weersing VR (2006). Depressive disorders in childhood and adolescence: an overview: epidemiology, clinical manifestation and risk factors. Child Adolesc Psychiatr Clin N Am. 2006;15:827-841

Agency for Healthcare Research and Quality (2010). The Guide to Clinical Preventive Services 2010-2011: Recommendations of the U.S. Preventive Services Task Force. Retrieved from: http://www.ahrq.gov/clinic/pocketgd1011/pocketgd1011.pdf

Wilkinson J, Bass C, Diem S, Gravley A, Harvey L, Maciosek M, McKeon K, Milteer L, Owens J, Rothe P, Snellman L, Solberg L, Vincent P. Institute for Clinical Systems Improvement. Preventive Services for Children and Adolescents. Updated September 2013. https://www.icsi.org/_asset/x1mnv1/PrevServKids.pdf

Centers for Disease Control and Prevention (2007). Web-based injury statistics query and reporting system (WISQARS), National Center for Injury Prevention and Control, 2005. Retrieved from:  http://www.cdc.gov/injury/wisqars/index.html

Geriatric Mental Health Foundation (2008). Depression in late life: not a natural part of aging, 2008. Retrieved from:  www.gmhfonline.org/gmhf/consumer/factsheets/depression_latelife.html

Steinman LE, Frederick JT, Prohaska T, Satariano WA, Dornberg-Lee S, Fisher R,…Snowden M (2007). Recommendations for treating depression in community-based older adults. American Journal of Preventive Medicine, 33(3), 175–81. Retrieved from:  www.ajpm-online.net/article/S0749-3797%2807%2900330-3/abstract

Unutzer J, Schoenbaum M, Katon WJ, Fan M, Pincus HA, Hogan D & Taylor J (2009). Health care costs associated with depression in medically ill fee-for-service Medicare participants. Journal of the American Geriatric Society, 57(3), 375–584. Retrieved from www.nimh.nih.gov/science-news/2009/health-care-costs-much-higher-for-older-adults-with-depression-plus-other-medical-conditions.shtml

U.S. Preventive Services Task Force (2009). Screening for Depression in Adults: U.S. Preventive Services Task Force Recommendation Statement. Annal of Internal Medicine, 151 (11), 784-792. Retrieved from: http://annals.org/article.aspx?articleid=745304

Mitchell J, Trangle M, Degnan B, Gabert T, Haight B, Kessler D, Mack N, Mallen E, Novak H, Rossmiller D, Setterlund L, Somers K, Valentino N, Vincent S. Institute for Clinical Systems Improvement. Adult Depression in Primary Care. Updated September 2013. https://www.icsi.org/_asset/fnhdm3/Depr.pdf

Screening:
Completion of a clinical or diagnostic tool used to identify people at risk of developing or having a certain disease or condition, even in the absence of symptoms.  
Standardized Depression Screening Tool – A normalized and validated depression screening tool developed  for the patient population in which it is being utilized

Examples of depression screening tools include but are not limited to: 
•  Adolescent Screening Tools (12-17 years) 
  o  Patient Health Questionnaire for Adolescents (PHQ-A)
  o  Beck Depression Inventory-Primary Care Version (BDI-PC)
  o  Mood Feeling Questionnaire(MFQ)
  o  Center for Epidemiologic Studies Depression Scale (CES-D)
  o  PRIME MD-PHQ2 
•  Adult Screening Tools (18 years and older) 
  o  Patient Health Questionnaire (PHQ9)
  o  Beck Depression Inventory (BDI or BDI-II)
  o  Center for Epidemiologic Studies Depression Scale (CES-D)
  o  Depression Scale (DEPS)
  o  Duke Anxiety-Depression Scale (DADS)
  o  Geriatric Depression Scale (SDS)
  o  Cornell Scale Screening
  o  PRIME MD-PHQ2 

Follow-Up Plan: 
Documented follow-up for a positive depression screening must include one or more of the following:
 •  Additional evaluation for depression
 •  Suicide Risk Assessment
 •  Referral to a practitioner who is qualified to diagnose and treat depression
 •  Pharmacological interventions
 •  Other interventions or follow-up for the diagnosis or treatment of depression

A clinical depression screen is completed on the date of the encounter using an age appropriate standardized depression screening tool AND if positive, a follow-up plan is documented on the date of the positive screen. 
Screening Tools:
 •  The name of the age appropriate standardized depression screening tool utilized must be documented in the medical record 
 •  The depression screening must be reviewed and addressed in the office of the provider, filing the code, on the date of the encounter
  o  The screening and encounter must occur on the same date
 •  Standardized Depression Screening Tools should be normalized and validated for the age appropriate patient population in which they are used and must be documented in the medical record
Follow-Up Plan:
 • The follow-up plan must be related to a positive depression screening, example: “Patient referred for psychiatric evaluation due to positive depression screening.”

TBD

All patients aged 12 years and older before the beginning of the measurement period with at least one eligible encounter during the measurement period.

Equals Initial Patient Population

Patients with an active diagnosis for Depression or a diagnosis of Bipolar Disorder

Patients screened for clinical depression on the date of the encounter  using an age appropriate standardized tool AND if positive, a follow-up plan is documented on the date of the positive screen

Not Applicable

Patient Reason(s)
Patient refuses to participate 
OR
Medical Reason(s)	
Patient is in an urgent or emergent situation where time is of the essence and to delay treatment would jeopardize the patient’s health status 
OR
Situations where the patient’s functional capacity or motivation to improve may impact the accuracy of results of standardized depression assessment tools.  For example: certain court appointed cases or cases of delirium

Not Applicable

Not Applicable

For every patient evaluated by this measure also identify payer, race, ethnicity and sex.