Telephonic case-finding of major depression in a Medicaid chronic disease management program for diabetes and heart failure

Ronald T. Ackermann, Marc B. Rosenman, Stephen M. Downs, Ann M. Holmes, Barry P. Katz, Jingjin Li, Alan J. Zillich, Caroline P. Carney, Thomas S. Inui

Research output: Contribution to journalArticle

20 Scopus citations

Abstract

Objective: Major depression is common in low-income and chronically ill persons and is a barrier for effective chronic disease care. We evaluated a Medicaid-sponsored strategy for detecting depressive symptoms in adults with diabetes or congestive heart failure. Methods: Using a two-item screening tool, 890 adults enrolled in the Indiana Chronic Disease Management Program were assessed by telephone for depressive symptoms between December 2003 and March 2004. A subset of 386 participants also completed the eight-item Patient Health Questionnaire (PHQ-8) depression measure. Antidepressant use was examined using pharmacy claims. Results: Depressed mood or anhedonia was reported by 51% of participants. About one in four participants had a PHQ-8 score indicating a high risk for major depression (score ≥10). The two-item screen was 96% sensitive [95% confidence interval (CI), 89-99%] and 60% specific (95% CI, 54-65%) for identifying members at high risk for depression by the full PHQ-8 instrument. Only half of participants with high-risk PHQ-8 scores had a pharmacy claim indicating that an antidepressant medication was filled within 120 days of the depression screening. Conclusions: A two-stage, telephonic approach involving the PHQ-8 instrument for Medicaid members with either depressed mood or anhedonia could identify two clinically depressed persons for every nine members screened.

Original languageEnglish (US)
Pages (from-to)338-343
Number of pages6
JournalGeneral Hospital Psychiatry
Volume27
Issue number5
DOIs
StatePublished - Sep 1 2005

Keywords

  • Chronic disease
  • Depression
  • Disease management
  • Mass screening
  • Medicaid

ASJC Scopus subject areas

  • Emergency Medicine
  • Medicine(all)
  • Psychiatry and Mental health

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