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Missed Opportunities for Depression Screening in Patients with Arthritis in the United States

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ABSTRACT

BACKGROUND

Arthritis affects 20 % of the adult US population and is associated with comorbid depression. Depression screening guidelines have been endorsed for high-risk groups, including persons with arthritis, in the hopes that screening will increase recognition and use of appropriate interventions.

OBJECTIVE

To examine national rates of depression and depression screening for patients with arthritis between 2006 and 2010.

PARTICIPANTS AND DESIGN

We used nationally representative cross-sections of ambulatory visits in the United States from the National Ambulatory Medical Care Survey from 2006 to 2010, which included 18,507 visits with a diagnosis of arthritis. When weighted to the US population, this total represents approximately 644 million visits.

MEASUREMENTS

Visits where arthritis was listed among diagnoses. Outcomes were survey-weighted estimates of depression and prevalence of depression screening among patients with arthritis across patient and physician characteristics.

KEY RESULTS

Of the 644,419,374 visits with arthritis listed, 83,574,127 (13 %) were associated with a comorbid diagnosis of depression. The odds ratio for comorbid depression with arthritis was 1.42 (95 % CI 1.3, 1.5). Depression screening occurred at 3,835,000 (1 %) visits associated with arthritis. When examining the rates of depression screening between ambulatory visits with and without arthritis listed, there was no difference in depression screening rates; both were approximately 1 %. There was no difference in screening rates by provider type. Compared to visits with other common, chronic conditions, the prevalence of depression at arthritis visits was high (13 per 100 visits), although the prevalence of depression screening at arthritis visits was low (0.68 per 100 visits).

CONCLUSIONS

Despite the high prevalence of depression with arthritis, screening for depression was performed at few arthritis visits, representing missed opportunities to detect a common, serious comorbidity. Improved depression screening by providers would identify affected patients, and may lead to appropriate interventions such as mental health referrals and/or treatment with anti-depressants.

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Acknowledgements

Support

Dr. Margaretten is supported by the National Center for Advancing Translational Sciences, National Institutes of Health, through UCSF-CTSI Grant Number KL2TR000143. This papers’ contents are solely the responsibility of the authors and do not necessarily represent the official views of the NIH. Dr. Margaretten also received support from The Rosalind Russell Medical Research Center for Arthritis Research. The funding sources had no role in the design and conduct of the study, analysis or interpretation of the data, or preparation of final approval of the manuscript prior to publication.

Conflict of Interest

The authors declare that they do not have a conflict of interest.

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Authors and Affiliations

  1. Division of Rheumatology, Department of Medicine, University of California San Francisco, San Francisco, CA, USA

    Mary E. Margaretten MD, MS, Patricia Katz PhD, Gabriela Schmajuk MD, MS & Edward Yelin PhD

  2. Division of Rheumatology, Department of Medicine, San Francisco VA Medical Center, San Francisco, CA, USA

    Gabriela Schmajuk MD, MS

  3. Arthritis Research Group UCSF, 3333 California Street, Suite 270, San Francisco, CA, 94118, USA

    Mary E. Margaretten MD, MS

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  1. Mary E. Margaretten MD, MS
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Correspondence to Mary E. Margaretten MD, MS.

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Margaretten, M.E., Katz, P., Schmajuk, G. et al. Missed Opportunities for Depression Screening in Patients with Arthritis in the United States. J GEN INTERN MED 28, 1637–1642 (2013). https://doi.org/10.1007/s11606-013-2541-y

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