Identifying, Screening and Treating Depression

By Valerie M. Kading, DNP, MSN
Director of Medical Operations, Sierra Tucson

October marks two days dedicated to highlighting depression and the potentially devastating effects of the loss of a pregnancy or child. National Depression Screening Day, on October 6, is devoted to educating the public on stigma reduction and improvement of access to treatment for individuals and families suffering from depression. Pregnancy and Infant Loss Remembrance Day, on October 15, is a day in which those who have suffered a miscarriage, stillbirth, ectopic pregnancy, or loss of an infant, can commemorate their babies.

Depression is a global health burden and leading cause of disability that affects over 350 million individuals worldwide. In the United States, over 15 million adults (or 6.7 percent) experience depression, which is the primary cause of disability for individuals ages 15 to 44. At any given time, more than 1 out of 20 Americans older than 12 years of age report current depressive symptoms. Approximately 42,700 individuals will die by suicide each year (CDC, 2016) and sadly, most suicides may have been prevented.

Depression takes a devastating toll on the individual and his or her loved ones. Depression can present throughout one’s life and can occur during childhood, adulthood, pregnancy, postpartum, and later years. Major depressive disorder (MDD) is diagnosed when a person experiences five or more or the following symptoms for at least two weeks: depressed mood, anhedonia, weight or appetite changes, psychomotor agitation, sleep disturbances, lack of energy, thoughts of death, or difficulty concentrating. These symptoms can cause significant impairment in a person’s relationships with others, work performance, and daily functioning. Depression is associated with trauma and/or significant life events such as divorce, loss of a loved one, medical impairments, and comorbid psychiatric conditions including anxiety, disordered eating, and substance use. Untreated depression is also associated with an increased risk of suicide and other causes of mortality, including heart disease.

Treatment options for depression include counseling, pharmacological interventions, naturopathic remedies, exercise, acupuncture, transcranial magnetic stimulation (TMS), psychoeducation, and integrative therapies. While various treatment modalities for depression exist, significant barriers delay or prohibit the treatment of depression. One barrier is stigma. Individuals often feel embarrassed or ashamed to seek help. Also, family members, loved ones, or health care providers may not support treatment based on negative societal views or personal beliefs about mental illness. Another barrier is a health care provider’s knowledge on how to identify, screen, or treat depression. He or she may not know how to comfortably engage in conversations and assess for depression, or may have time constraints that impact his or her ability to adequately identify and comprehensively treat depression.

Screening for depression is vital in the identification and treatment of depression. In September 2016, the U.S. Preventive Services Task Force (USPSTF) clearly articulated recommendations for screening the general adult population, including pregnant and postpartum women. The USPSTF also recommended that screening occur in the context of availability of adequate resources for diagnosis, treatment, and follow-up care. Several tools are available to screen for depression in adults, with the Patient Health Questionnaire (PHQ-9) being the most common. The PHQ-9 is a brief and validated self-administered tool that health care providers can give to patients and is easily accessible online. An appropriate screening tool for the elderly population is the Geriatric Depression Scale, while the Edinburgh Postnatal Depression Scale (EPDS) is the appropriate screening tool for pregnant and postpartum women.

Health care providers should routinely screen all patients for depression. It is especially vital to screen those who have a known family history of depression and/or suffered a recent loss or traumatic event. Once screening has been completed, treatment is warranted. Appropriate referral to a psychiatric provider or more intensive psychiatric care may be necessary if depressive symptoms are significantly impacting the person’s ability to function or remain safe.

Please call our Admissions Coordinators at (800) 842-4487 for more information about Sierra Tucson’s residential treatment for depression. There is hope.