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Depression

Behavioral Health Guideline

Research shows that five to nine percent of all outpatients seen in the primary care setting have a major depressive disorder. Almost 35 million adults in the United States will suffer from a major depressive disorder during their lifetime. For adults with a chronic illness such as diabetes, the number is even higher (two to three out of every 10). Despite its high prevalence and its subsequent economic impact, depression often goes unrecognized in the primary care setting.

Paramount endorses the United States Preventive Services Task Force Guideline USPSTFG recommendation to screen all adults and adolescents for depression in the primary care setting. Asking the following two questions may be as effective as the use of longer screening instruments:

  1. Over the past two weeks, have you ever felt down, depressed or hopeless?
  2. Over the past two weeks, have you felt little interest or pleasure in doing things?

All positive screenings should trigger a full diagnostic interview using standard diagnostic criteria to determine the presence or absence of specific depressive disorders.

Paramount recommends the use of Clinical Practice Guideline – Outpatient Treatment of Major Depression in Adults (Adolescents), based on the Agency for Health Care Policy and Research's Depression in Primary Care (Vol. 1, Detection and Diagnosis and Vol. 2, Treatment of Major Depression). These guidelines incorporate the March 2009 updated recommendations from the USPSTFG and are consistent with Paramount's goal to utilize evidence-based outcomes to direct appropriate care for members with depression.

Recognizing the importance of appropriate treatment, NCQA developed the following HEDIS® measure specific to depression and mental illness:

  • The percentage of members, age six and older, hospitalized for treatment of selected mental health disorders and seen on an ambulatory basis within 7 and within 30 days of discharge.