Two simple questions help spot depression

Study says screening important, easy to do

"Over the past two weeks, have you felt down, depressed, or hopeless?" and "Over the past two weeks, have you felt little interest or pleasure in doing things?" Those two simple questions may be as effective as more complex tools in helping to spot employees who may be suffering from depression and in identifying those workers who should be referred for a thorough diagnostic workup.

With proper diagnosis and treatment following the two-question screening, workers suffering from depression are likely to experience significant clinical improvement and, as a result, be more productive at work. These are among the most significant assertions in A Screening Program for Depression, a new statement from the Arlington Heights, IL-based American College of Occupational and Environmental Medicine (ACOEM). In its statement, ACOEM:

• Endorses the report of the U.S. Preventive Services Task Force (USPSTF) on Screening for Depression;

• Takes the position that screening is an appropriate part of the practice of clinical occupational medicine, which can be a valuable addition to acute injury or illness care, fitness for duty evaluations, and clinical preventive medical examinations.

"This not uncommon disorder can wreak havoc with the health and productivity of workers and their families," notes Alan Engelberg, MD, chairman of ACOEM’s Occupational Mental Health Committee and director of programs and global processes in global occupational health services for IBM, in Somers, NY.

What the USPSTF found

The USPS Task Force, a panel of specialists in preventive medicine, reviews existing literature and has come up with what Ebgelberg calls "very specific and critically tight guidelines on how to apply the evidence and produce reports." Its key findings are as follows:

• There is good evidence that screening improves the accurate identification of depressed patients in primary care settings and that treatment of depressed adults identified in primary care settings decreases clinical morbidity.

• Large benefits have been observed in studies in which the communication of screening results is coordinated with effective follow-up and treatment.

• Many formal screening tools are available. However, asking two simple questions about mood and anhedonia (a state in which an individual is unable to feel joy) may be as effective as using any of the longer screening instruments.

• Clinical practices that screen for depression should have systems in place to ensure that positive screening results are followed by accurate diagnosis, effective treatment, and careful follow-up. Benefits from screening are unlikely to be realized unless such systems are functioning well.

Screening not enough

It’s important to remember, Engelberg emphasizes, that it’s not enough just to screen. "If you’re talking about an occ-med physician, workplaces and clients will often have an EAP [employee assistance program], as will some hospitals," he notes. "Otherwise, you should be set up with a psychiatrist or psychologist. The important thing is to have someone to follow up."

But it is the occupational health professional who actually asks the two screening questions, notes Engelberg. "What the task force basically says is that you can have the standard clinic population come in and just ask the questions as you would any questions in a medical history," he says. "If you ask these questions, you’ll pick up depression you might not otherwise pick up."

Another key point ACOEM makes in its statement is that presenteeism (when workers report to work, but are not performing up to par) is the largest single cost of depression — all the more reason to screen for employees who may need help. "What we’re trying to say here, and more and more studies are coming out to support this, is that there are people who continue to go to work who have various medical conditions that affect their productivity at work. So this is an evidence-based conclusion."

[For more information, contact: Alan Engelberg, MD, director of programs and global processes in global occupational health services, IBM, Somers, NY. Telephone: (914) 766-0237.]