UK propose to screen all Long term illness/chronic illness patients for depression

The_Conductor

http://www.timesonline.co.uk/tol/life_and_style/health/article6893855.ece

People suffering from chronic conditions such as cancer, diabetes, respiratory problems and heart disease should be screened by GPs for depression, according to new NHS guidance.

The recommendation has been made in response to concerns about high rates of depression among Britain’s 17 million sufferers of chronic illness, and a lack of awareness among NHS staff.

The report, published by the National Institute for Health and Clinical Excellence (Nice), also sets out guidance on drug use to ensure that treatment for depression does not conflict with other medications patients may be taking.

People with chronic conditions are estimated to be two or three times more likely to be depressed than those who are healthy. Almost one in six of the general population is affected by depression, irrespective of long-term health problems.

The advisory board said that GPs should screen for depression by asking a series of questions about the patient’s wellbeing, rather than just focusing on physical symptoms of an illness.

Research has shown that treating depression in people with chronic health problems can improve their symptoms.

The new guidance, which is for adult patients, sets out two key questions patients should be asked if a doctor suspects they may be at risk of depression. They are: “During the last month, have you often been bothered by feeling down, depressed or hopeless?” and “Have you had little interest or pleasure in doing things?”

If the patient says yes, the doctor should refer him or her to a specialist or, if they are trained in mental health assessment, ask a further three questions.

These will check if the patient has, in the last month, been bothered by feelings of worthlessness, poor concentration or thoughts of death.

The doctor should also consider if the patient is receiving the best kind of treatment for their physical health problem, and ask about any history of depression and relationships or living conditions.

Antidepressants should not be given routinely but should be considered for people with more severe depression alongside services such as cognitive behavioural therapy, the guidance recommends.

Professor Stephen Pilling, director of the National Collaborating Centre for Mental Health, said that Nice had decided to issue the new guidance because of the impact depression could have on chronic illness.

“There is a greater incidence of depression [in this patient population]. This presents a problem, but more importantly there is also the rather pernicious interaction with chronic health problems which has been shown to increase both morbidity and mortality.”

Dr David Kessler, a GP and Walport clinical lecturer in primary care at Bristol University, said that some doctors got “wrapped up” in treating physical symptoms but needed to be aware of the “background” of possible depression.

“Living with a chronic health problem can and often does affect mental wellbeing; it can cause or intensify depression. We need to ask people with chronic health problems if they are suffering from depression.

“This new guideline is important in raising awareness among patients and doctors of the combination of the two conditions and helping them identify symptoms early and more effectively.”

Dr John Hindle, a consultant physician who specialises in elderly medicine in North Wales, said: “There’s evidence that treating depression in a condition like Parkinson’s disease can improve function.

“Treating mental health problems can actually improve a patient’s independence.”

Andrew Harrop, head of public policy for Age Concern and Help the Aged, said the guidance was welcome, but added that the recommended range of treatments was not being offered to many older patients.

“Depression is the most common mental health problem in later life, affecting one in four older people, yet it is often overlooked by GPs and health professionals and wrongly seen as part of growing old,” he said. “For many older people it’s a serious illness that if left unidentified and untreated, can lead to a life of misery.”

The World Health Organisation’s annual global health risks report, published yesterday, concluded that depression is the leading cause of years lost due to illness.

sam34

while this is intrinsically a good initiative, as untreated depression can have devastating consequences. the "checklist" approach bothers me a little.

an assessment of someone's mental state is much more than 5 yes/no questions.

LegacyUser

sam34 wrote: »

while this is intrinsically a good initiative, as untreated depression can have devastating consequences. the "checklist" approach bothers me a little.

an assessment of someone's mental state is much more than 5 yes/no questions.

Am I being cynical in thinking that this is just an attempt by the NHS to try and weed out those people with LTI's on disability payment who may be able to undertake some form of work if they were less depressed rather than to improve or address quality of life issues for the majority of long term ill. A checklist seems a very tokenist approach.

rebel girl 15

Its a good initiative - because it does happen. Someone out of work for ages with a long term illness can get depressed very easily, same as someone in work with a chronic illness; the same battle everyday, the constant struggle with it.

A healthy body is a healthy mind in the phrase that comes into my head reading it - but as sam said above, five questions is very few, two if the GO isn't trained in mental health issues. I presume the GP would go into details about the first two before carting them off; is it a case of bad day syndrome or a constant thing?