Depression Awareness and Importance of Screening

Among persons older than 65 years, one in six suffers from depression. Depression in older adults is estimated to occur frequently when battling illnesses including cancer, arthritis, stroke, chronic lung disease, chronic pain and cardiovascular disease. Other stressful events, such as the stress experienced in caring for loved ones with a serious illness or disability, a new medical diagnosis, the loss of friends and loved ones, financial worries, genetics, sleep problems, social isolation and/or loneliness, lack of or change in physical activity, changes in activities of daily life, and/or struggles with addiction are also risk factors for depression. Opportunities are missed to improve health outcomes when mental illness is under-recognized and under-treated in primary care settings.

We define a primary care setting as a place where clinicians deliver integrated, accessible health care services and are responsible for addressing most patient health care needs, developing a sustained patient partnership, and practicing in the context of family and community. Under this direction, we don’t consider emergency departments, inpatient hospital settings, ambulatory surgical centers, independent diagnostic testing facilities, skilled nursing facilities, inpatient rehabilitation facilities, and hospices as primary care settings.

According to the CDC, adults aged 75 and older have one of the highest suicide rates (20.3 per 100,000). Men aged 75 and older have the highest rate (42.2 per 100,000) compared to other age groups. Non-Hispanic white men have the highest suicide rate compared to other racial/ethnic men in this age group (50.1 per 100,000). These patients are important in the primary care setting because 50-75 percent of older adults who commit suicide saw their medical doctor during the prior month for general medical care, and 39% were seen during the week prior to their death.

If you are a health care provider of an older person, ask how they are feeling during their visits. Research has shown that intervening during primary care visits is highly effective in reducing suicide later in life.

Depression is more than just feeling down or having a bad day. When a sad mood lasts for a long time and interferes with normal, everyday functioning, patients may be depressed. 

Based upon authority to cover “additional preventive services” for Medicare beneficiaries if certain statutory requirements are met, the Centers for Medicare & Medicaid Services (CMS) initiated a new national coverage analysis on screening for depression in adults. Screening for depression in adults is recommended with a grade of B by the U.S. Preventive Services Task Force (USPSTF) and is appropriate for individuals entitled to benefits under Part A and Part B.

Therefore, effective October 14, 2011, CMS will cover annual screening for depression for Medicare beneficiaries in primary care settings that have staff-assisted depression care supports in place to assure accurate diagnosis, effective treatment, and follow-up. Various screening tools are available for screening for depression. CMS does not identify specific depression screening tools. Rather, the decision to use a specific tool is at the discretion of the clinician in the primary care setting. 

Coverage is limited to screening services and does not include treatment options for depression or any diseases, complications, or chronic conditions resulting from depression, nor does it address therapeutic interventions such as pharmacotherapy, combination therapy (counseling and medications), or other interventions for depression.

Resources

• Mental Health Conditions: Depression and Anxiety
• Risk and Protective Factors for Suicide
• Depression Screening — MLN006559 (Medicare Preventive Services webpage)
• Screening for Depression in Adults (NCD -210.9)
• Depression and Older Adults