Prevention & Screening
The primary prevention of MDD depends on socioeconomic and biologic strategies that alter risk factors, such as economic deprivation, child abuse and neglect, and genetic predisposition. Probably the most that can be done at present, however, is in the realm of secondary and tertiary prevention. This involves overcoming barriers to timely recognition and treatment of MDD. Education, universal access to treatment, and provision of uniformly effective treatments are important and as-yet-unachieved goals.
Survey instruments can be used to assist in diagnosing MDD (see Table 1). They have been used either to screen for depression and other common psychiatric disorders or to verify and reinforce the diagnosis of clinical impression. Survey instruments can be completed by hand, telephone, or computer without requiring the clinician’s valuable time. An important incidental finding in studies using computer-driven technologies is that patients are more likely to reveal personal information to a computer than they are in a face-to-face clinical encounter.
Once sensitive information surfaces, it must be dealt with. The clinician’s response to information about hopelessness or suicidal ideation, for example, has important clinical and potential legal ramifications. Rather than ignoring or avoiding such information, a more effective measure is to delegate responsibility for follow-up to another clinician in the practice (e.g., physician’s assistant, clinical nurse specialist). On-site collaboration with one or more mental-health specialists (nurse clinician, psychiatrist, psychologist, social worker) has been found to offer the most effective means of dealing with the problem of depression in primary care.18