Brief Depression Questionnaires Double Depression Diagnoses

Rob Wipond
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After family physicians and other primary care medical doctors gave patients who were not depressed a common, brief depression questionnaire to complete, the physicians then diagnosed 20% of them with depression and over half were given antidepressants, according to a study in the Journal of the American Board of Family Medicine.

The exploratory study was led by the University of California – Davis Health System, and included 595 patients of primary care offices affiliated with a variety of major California care providers.

Patients were selected for the study specifically on the basis of the fact that they’d been identified as being at relatively low risk for depression. The researchers then tracked how many of the patients were asked by their physicians to complete one of two depression questionnaires commonly used in primary care (the Patient Health Questionnaire-9 and PHQ-2), and how many got diagnosed with depression.

“Of the 545 patients who did not complete brief depression questionnaires during their doctors’ office visits, 10.5 percent were diagnosed with depression and 3.8 percent were prescribed antidepressants. Of the 50 patients who completed brief depression questionnaires during their doctors’ office visits, 20 percent were diagnosed with depression and 12 percent were prescribed antidepressants,” stated a UC Davis press release about the study. “[Lead author Anthony Jerant] said the study highlights the need for research to determine the best ways to apply brief depression questionnaires in daily practice, as use of the screeners tripled the likelihood that patients in the study who were not apt to be depressed would receive depression treatment.”

“It is important to treat depression, but equally important to make sure those who get treatment actually need it,” Jerant said in the press release. “We need to give providers good guidance on how to use brief symptom measures in evaluating patients and making treatment decisions.”

Brief depression questionnaires could lead to unnecessary antidepressant prescriptions (UC Davis Press Release on ScienceDaily, September 29, 2014)

(Full Text) Potential Antidepressant Overtreatment Associated with Office Use of Brief Depression Symptom Measures. (Jerant, A. et al. The Journal of the American Board of Family Medicine. September-October 2014. DOI: 10.3122/jabfm.2014.05.140038)

12 COMMENTS

  1. My PCP gave me one of these questionnaires after I had avoided answering it online. I was furious but of course feared if I had expressed anger, that would be a sign of depression (rolling my eyes) so I played the good cooperative patient and answered the questions correctly.

    My question to the good folks on this site is god forbid if I encounter this situation again, what would be a good way of refusing this and getting my point across? Yes, I now realize I could outright refuse it but I guess what I am asking is what would be a good boiler plate 2 minute speech to educate docs that this is the wrong move.

    Thanks!

  2. AA

    You might begin by stating how wrong it is to pathologize human emotions and difficulties of life, and things like sadness. Then you could jump to Irving Kirsch’s study that shows that the so-called “antidepressants” work no better than placebo so you might as well go out and buy yourself some candy and be just as well off, or better, than if you took the damned toxic drugs that the drug companies are trying to shove down everyone’s throats.

    • Thanks Stephen. I will think I will say I am uncomfortable with a questionnaire that pathologizes human emotions which included throwing drugs at a problem.

      By the way after reading this blog entry, I was really angry with myself for taking this questionnaire. Live and learn.

  3. “use of the screeners tripled the likelihood that patients in the study who were not apt to be depressed would receive depression treatment.”
    Why am I not surprised? These questionnaires are ridiculous to begin with, at par with “psychology tests” in woman’s magazines. What did they expect, really?

  4. “We need to give providers good guidance on how to use brief symptom measures in evaluating patients and making treatment decisions.”

    I have some good guidance – toss them in the trash can! Anything that can give that many “false positives” is worse than useless. As an alternative, I suggest a radical concept – instead of giving them a questionnaire, why not try TALKING with them and taking some time to understand their lives?

    —- Steve

    • Not going to happen Steve during a 15 minute appointment that is now reduced to about 10 to 12 minutes due to the use of medical records. Instead, it is all about quick fix medicine.

      Of course, I agree with you but I am just being realistic. Heck, doctors don’t even stop long enough to listen to non psych issues for crying out loud.

  5. From the Patient Health Questionnaire-9 study: Kroenke K, Spitzer RL. The PHQ-9: a new depression diagnostic and severity measure. Psychiatr Ann 2002;32:509–21 comes this disclosure re the lead author: “Dr. Kroenke’s research is supported by Pfizer Inc. and Eli Lilly. He is also
    a member of Eli Lilly’s advisory board.” Enough said. Herding patients to the pharmacy.

  6. Thanks s1w2f3 and Rob. If god forbid, I encounter a similar type situation, I will ask about financial disclosures and make the point that human emotions shouldn’t be pathologized. I am still mad at myself for not speaking up when I had the chance but I don’t plan on making the same mistake again. I am so tired of this garbage.

  7. You would think that more people would use their good sense about this and refuse the drugs at all costs.

    Why are so many people willing to jump on the bandwagon and blindly take all this without evaluating everything first. If you are not “depressed” to begin with, why would you let some doctor, who probably doesn’t even know you since they don’t spend any time these days getting to know their patients, convince you that you’re “depressed” and that you need to take these dangerous drugs?

    Just because some doctor makes some big pronouncement does not mean that I’m going to blindly fall into line and bow down to her or his whim. I learned a long time ago while working in hospitals, that there are lots of doctors who don’t really have a clue at all about most anything but they believe that everyone needs to do exactly as they say because they went to school for 8 years.

  8. Hi Stephen,

    Unfortunately, people fear if they argue with their doctor, they will be seen as a “bad” patient. I know that was my thought process when I was given this questionnaire. But in retrospect, that really hasn’t gotten me anywhere so as a result, I am changing my approach.

    And then there are people who think well, if the doctor is administering the questionnaire, they must know what they are doing since doctors can’t do no wrong, right?

    Finally, I also think people get worn down. I had disagreed with my doctor about the way she categorized a diagnosis and in response, blamed it on the medical records electronic template saying she couldn’t do anything about it. In my opinion, that was BS but I was just too tired to argue with her and worried that it would take up my whole appointment when I had pressing issues to discuss. I may write another letter although I am not really sure it will matter.

    • I hear what you’re saying. I guess what really helped me in learning to deal with doctors is that we were taught in my family to only search out a doctor as a last response for your problem. You were supposed to try everything else before turning things over to one of them.

      Also, being trained and working in hospitals, both medical and psychiatric. helped me see and realize that there is nothing really special at all about those people who have M.D. printed behind their names. They are people, just like everyone else and you can question them and call them to account. They may no longer take you as a patient but if that happens you didn’t need them in the first place and deserve someone better to look after your health needs.

      I’ve had an advanced nurse practitioner for the past six years and am well pleased with the things she does for me. We actually collaborate in making decisions about my health care and she treats me as a genuine equal in all things. She sits down and spends time actually listening to what I have to say and she looks at me while we’re talking together. She knows how to communicate and it’s always a give and take process when I go in for my checkups.

      I fired the doctor I had before her after two office visits. He had the audacity to tell me that I had no choice in my treatment and that I would do as he said! I laughed and pointed to my feet as I stated that I did have choice in the matter. He asked me what I was talking about and I got up, wished him a good day, and walked out of his office, never to return. I’m too old to put up with disrespect like that.

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