Taking depression screening to the next level

Neeta Goel, MD, is a board-certified family physician and chief medical officer for Inova’s ambulatory (outpatient) sites of care. She practices family medicine at Inova Primary Care — Ashburn HealthPlex.

Depression is diagnosed in one in five adults in the United States. But for many other people, it often goes undiagnosed. In a 2022 survey of U.S. adults, more than 31 percent of participants showed signs of moderate to severe depression without having a formal diagnosis.

It’s easy to understand how depression goes undiagnosed — it’s hard to ask for help if you don’t recognize depression symptoms or worry about the stigma that exists around depression. But like many other chronic conditions, including cancer and diabetes, screening can help identify depression symptoms and encourage diagnosis. The challenge is putting effective screening in place.

Inova Health’s new approach to depression screening

Most primary care providers (PCPs) conduct depression screening at annual check-ups. But not all patients see a primary care physicians every year and those people may fall through the cracks when it comes to depression screening.

To make depression screening more widely available, Inova is taking a team approach. In spring 2023, Inova introduced Wellness Screening, a more comprehensive approach to depression screening. Patients who see any Inova provider at an outpatient site undergo yearly depression screening, regardless of whether that provider is a specialist or a PCP.

In the six months since launching the wellness screening approach, Inova screened 260,000 people. About 55,000 of those screenings took place at specialty sites. More than 600 patients screened in the specialty clinics had thoughts of hurting themselves and were provided with the resources and help they needed.

How does depression screening work?

Wellness screening is a self-administered Patient Health Questionnaire (PHQ). It’s conducted through MyChart when you complete an electronic check-in for your appointment. If you don’t check in through MyChart, your provider’s office will conduct the screening in person during your appointment.

The PHQ asks two initial questions about how often, over the past two weeks, you’ve experienced:

1. Little interest or pleasure in doing things
2. Feeling down, depressed or hopeless

Depending on your response, you may receive seven more questions, one of which asks about thoughts of self-harm. If your screening shows any signs of depression, MyChart or your provider will guide you to mental health resources. People who are severely depressed, have thoughts of self-harm or need immediate assistance are connected with an on-call behavioral health therapist.

Screening for depression in children

Inova is also screening children and teens ages 12 to 18 for depression, which affects about 13 percent of kids in this age range. Teens may not always show typical signs of depression but still be at risk for suicide or self-harm. 

Depression screening for children requires a different approach than the two-question survey used for adults. The screening asks kids nine questions about how often they experience:

• Feeling badly about themselves or feeling they are a failure or have let their family down
• Feeling tired or having little energy
• Little interest or pleasure in doing things they used to enjoy
• Trouble concentrating on things like schoolwork, reading or watching TV
• Thoughts that they would be better off dead or of hurting themself

Children will answer the screening questions while in the provider’s clinic. The child’s doctor will review and address their responses during the appointment, usually after asking the parent to leave the room.

People at higher risk for depression

For many people, screening once a year is sufficient. But depression screening may be performed more often in some patient populations, including people who have:

• Cancer
• Chronic disease
• Previous mental health issues

Your PCP will discuss additional screening with you and use your current and past health history to guide the decision to screen more frequently.

Recognizing the signs of depression

Depression is more common in the winter months when you may experience less natural sunlight, feelings of stress or grief associated with the holidays, and a drop in socializing after the holidays pass. Depression that only occurs in the winter is called Seasonal affective disorder. It lasts about 40 percent of the year and affects 5 percent of U.S. adults.

Speak to your PCP or any Inova provider if you experience:

• Changes in your appetite
• Decreased interest in being social
• Lack of joy
• Trouble sleeping or sleeping too much
• Unusual fatigue or a drop in energy level

Help for depression at Inova and beyond

You don’t have to manage depression on your own. Your PCP or behavioral health specialist can connect you with resources to help. Inova offers inpatient mental health care, a partial hospitalization program and several outpatient services for mental health, including:

• Individual therapy and counseling, offered as a short-term or long-term treatment
• Integrated behavioral health services, which is a comprehensive approach to your physical health and mental wellness
• Medication management that considers the medicine’s benefits, side effects and possible interaction with other medications

If you need mental health support and help immediately, your options include:

• Calling or texting 988, a national 24/7 crisis hotline
• Visiting Inova Psychiatric Assessment Center (IPAC), a walk-in mental health clinic that works like an urgent care for psychiatric illness

Schedule an appointment
Inova PCPs offer appointments in the office and virtually. To set up a time to talk with your doctor about depression, schedule an appointment through your MyChart patient portal, or call your doctor’s office directly.