Don't Leave Depression To The Psychiatrists

The depression epidemic is a pervasive health crisis that has yet to receive the full attention it deserves. Healthcare professionals can take measures during the patients’ earlier stages of depression that can help provide a more effective form of diagnosis and care. Patient treatment of depression is usually only initiated after a particularly troublesome episode such as an instance of self-harm or attempted suicide. This is also the very worst stage of depression, and we can do better to start treatment earlier. By the time the patient has attempted self-harm, it might already be too late. Therefore, effective treatment of depression relies on a consistent method of early detection in patients who are prone to depression.

Traditional screening for depression involves the use of two standardized questionnaires: PHQ-2 and PHQ-9. It might seem that questionnaires are a convenient and timely way to screen for depression; after all, a questionnaire can be filled out with a pen and paper and doesn't require a physician to administer. However, here is where a breakdown between healthcare provider and patient occurs. From a diagnostic standpoint, many signs which might indicate a patient in need of help are taken away when the questionnaire is the main method of screening. For one, the physician does not see the patient face-to-face when the patient is answering these questions. This could lead to the physician missing many non-verbal cues or mannerisms exhibited by the patient that might be indicative of an imminent depressive crisis. Furthermore, patients might be more inclined to open up to a physician if he/she knows that the doctor is actively listening and paying attention to the patient’s answers. In other words, including depression screening in the medical interview would lead to more successful and effective screenings of mental health inadequacies.

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“… own ignorance and the negative stigma I had associated with depression delayed my diagnosis for years…”

Many students in high school, college, undergraduate education, post-baccalaureate studies, professional school, and residents experience a common onset of depression. My personal experience with depression is not representative of every patient’s struggle; each patient deals with depression in his or her own way, hopefully with the aid of a healthcare professional who is trained to handle such cases. However, I do think that my case could have been managed better on multiple fronts.

My experience with depression started long before my diagnosis, which seems to be the case more often than not in patients today. After all, one of the screening criteria is a formal suicide plan or attempt. This poses a problem in that many patients between the area of mental wellness and depression are missed, just because they haven’t experienced or are afraid to admit that they have suicidal ideations.

As for me, every doctor visit consisted staring at the floor, waiting for the history and physical exam to be finished. When asked questions designed to screen for positive depression, I would generally mumble the answers I thought were unremarkable without much thought to the questions. Furthermore, it was always either a paper questionnaire I ended up filling out or a tech conducting the interview without an upwards glance towards the patient as he or she filled in the answers for the doctor to glance at. I am quite confident that any competent health care professional, if told to specifically look for signs of depression, would have noticed something off in my wellness during any number of doctor visits I had during my college education. During that time, I remember being morose, stressed, lethargic, unmotivated, and complaining of sleeplessness. However, my own ignorance and the negative stigma I had associated with depression delayed my diagnosis for years. These years could have been spent as time taken for understanding my illness as well as possible therapy. I wish a single healthcare worker I interacted with would speak up. 

Depression is a huge problem in that it is more common than the average practitioners believes. Screening procedures are designed for time-based efficiency rather than efficacy. As a healthcare worker, we all know this, but we push off our responsibility to others. 

“Maybe a psychiatrist could deal with this better.” 
“Maybe the attending physician will say something.”
“Maybe they are just having a bad day.”
Maybe it is time to listen to our patients. 

Anthony Silvestre, MS-2, Ross University School of Medicine

Anthony Silvestre, MS-2, Ross University School of Medicine