Depression screening rates and symptom severity by alcohol use among primary care adult patients

Matthew E. Hirschtritt, Andrea H. Kline-Simon, Kurt Kroenke, Stacy A. Sterling

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Background: Hazardous alcohol use with depression may exacerbate health conditions and complicate medical care. We examined the rate of depression screening by alcohol use severity among primary care patients screened for hazardous alcohol use and, among those screened, examined patterns of significant depressive symptoms. Methods: Using cross-sectional data from primary care patients (n 2,894,906), we examined past-90day alcohol use (number of typical drinking days/week and typical number of drinks consumed daily); depression screening rates (using the Patient Health Questionnaire 9 [PHQ-9]); and symptom severity, demographics, and prevalence of selected psychiatric diagnoses. Results: Within 30 days of routine, in-clinic alcohol use screening by medical assistants, 2.4% (n 68,686) of patients also completed a PHQ-9; these patients were more likely to be female, younger, white, Medicaid insured, and to have a nondepressive psychiatric diagnosis and a lower Charlson comorbidity score. Abstainers and moderate drinkers (1 to 7 drinks/week or 1 to 4 drinks/week for women and individuals >65 years or for men <65 years, respectively) were less likely than hazardous drinkers (exceeding weekly limits) to complete the PHQ-9 or to have significant depressive symptoms (PHQ-9 score >10). Nonwhite patients with higher Charlson comorbidity scores were more likely to endorse significant depressive symptoms. Conclusions: Only a small fraction of patients in this cohort were screened for depression. Nonwhite patients and those with higher comorbidity burden were more likely to report depression but less likely to be screened. These discrepancies between depression-screening rates and significant depressive symptoms suggest that screening for depression should be enhanced in these at-risk groups.

Original languageEnglish (US)
Pages (from-to)724-732
Number of pages9
JournalJournal of the American Board of Family Medicine
Volume31
Issue number5
DOIs
StatePublished - Sep 1 2018

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Primary Health Care
Alcohols
Depression
Comorbidity
Mental Disorders
Health
Medicaid
Drinking
Demography

Keywords

  • Comorbidity
  • Cross Sectional Analysis
  • Depression
  • Patient Health Questionnaire
  • Primary Health Car

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health
  • Family Practice

Cite this

Depression screening rates and symptom severity by alcohol use among primary care adult patients. / Hirschtritt, Matthew E.; Kline-Simon, Andrea H.; Kroenke, Kurt; Sterling, Stacy A.

In: Journal of the American Board of Family Medicine, Vol. 31, No. 5, 01.09.2018, p. 724-732.

Research output: Contribution to journalArticle

Hirschtritt, Matthew E. ; Kline-Simon, Andrea H. ; Kroenke, Kurt ; Sterling, Stacy A. / Depression screening rates and symptom severity by alcohol use among primary care adult patients. In: Journal of the American Board of Family Medicine. 2018 ; Vol. 31, No. 5. pp. 724-732.
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AB - Background: Hazardous alcohol use with depression may exacerbate health conditions and complicate medical care. We examined the rate of depression screening by alcohol use severity among primary care patients screened for hazardous alcohol use and, among those screened, examined patterns of significant depressive symptoms. Methods: Using cross-sectional data from primary care patients (n 2,894,906), we examined past-90day alcohol use (number of typical drinking days/week and typical number of drinks consumed daily); depression screening rates (using the Patient Health Questionnaire 9 [PHQ-9]); and symptom severity, demographics, and prevalence of selected psychiatric diagnoses. Results: Within 30 days of routine, in-clinic alcohol use screening by medical assistants, 2.4% (n 68,686) of patients also completed a PHQ-9; these patients were more likely to be female, younger, white, Medicaid insured, and to have a nondepressive psychiatric diagnosis and a lower Charlson comorbidity score. Abstainers and moderate drinkers (1 to 7 drinks/week or 1 to 4 drinks/week for women and individuals >65 years or for men <65 years, respectively) were less likely than hazardous drinkers (exceeding weekly limits) to complete the PHQ-9 or to have significant depressive symptoms (PHQ-9 score >10). Nonwhite patients with higher Charlson comorbidity scores were more likely to endorse significant depressive symptoms. Conclusions: Only a small fraction of patients in this cohort were screened for depression. Nonwhite patients and those with higher comorbidity burden were more likely to report depression but less likely to be screened. These discrepancies between depression-screening rates and significant depressive symptoms suggest that screening for depression should be enhanced in these at-risk groups.

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