Detecting and Managing depression in primary care

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Depression is common among American Indians and Alaska Natives (AI/ANs). More AI/ANs are seen in general medical clinics than mental health settings where depression is often undetected by primary care providers. Only modest rates of follow-up, like antidepressant dispensation and mental health referrals occur upon detection. Treatment guidelines have been developed to improve depression detection and treatment, but provider adherence is largely unexamined. March 2001, the Southcentral Foundation, Inc. (an Alaska Native health care organization) implemented a comprehensive depression screening initiative entitled the "Depression Collaborative." The initiative mandates screening of all adult outpatients seen by primary care providers at the organization's Family Medicine clinic on the Alaska Native Medical Center campus. The initiative is considered an administrative success with a 60% completion rate, but concern remains about the needs of the 40% of patients not screened. This clinic also has implemented diagnostic and treatment guidelines that vary by severity of depression. Here, too, provider adherence remains unknown. Given the important questions surrounding this timely initiative, the specific aims of Research Project 3 are to: 1) describe patient and provider characteristics associated with missed depression screening in AI/ANs in primary care. 2) describe the demographic and clinical characteristics of AI/ANs who screen positive for depression. 3) identify how often providers note or diagnose depression when AI/ANs score positive on a screening instrument, as well as variables associated with notation and diagnosis, and 4) assess how often providers follow treatment protocols and factors which affect adherence. The research plan addresses these aims in two separate, but related phases. The first phase focuses on the detection process, which encompasses Aims 1 and 2. The second phase focuses on the management process, which encompasses Aims 3 and 4. This effort will be the first study with a sufficient sample size to provide insight into the differential distribution of depressive symptoms by age, gender, and clinical characteristics in a primary care setting. It also will be the first to examine the effectiveness of depression screening and treatment guidelines with an AI/AN population.