When a 29-year-old woman was admitted to Cedars-Sinai Medical Center for gallbladder removal in January, the staff nurse asked two questions that might have seemed irrelevant to the procedure.
“Have you felt down lately? Or had little interest in doing things?” the nurse inquired. The patient's response would significantly alter the care provided.
It turns out the woman had a history of major depression and post-traumatic stress disorder, and she was receiving regular infusion treatments of an antidepressant prescribed to people with severe mental illness.
Had the nurse not asked about depression, the hospital's clinicians might not have known to continue the infusions so the patient's mental-health treatment could continue uninterrupted. Nor would they have called in the psychiatrist who managed her care and educated the team on handling psychologically vulnerable patients.
“People tend to pull themselves together and look good on the outside,” said Dr. Itai Danovitch, chairman of the department of psychiatry and behavioral neurosciences at Los Angeles-based Cedars-Sinai. “But having a systematic mechanism helps to identify people with high levels of distress that have gone undetected.”
Since April 2014, the hospital has routinely screened all admitted patients for depression, making it one of the first U.S. hospitals to do so. About 1% of the 4,700 patients screened each month are found to be at risk for suicide, which hospital leaders say would have been hard to detect in the past.
Last week, the U.S. Preventive Services Task Force expanded its recommendations for depression screening to apply to all adults over age 18, including pregnant and postpartum women. The panel also said the benefits of mental-health treatment, even with antidepressants known to have side effects, far outweigh any potential risks.
While the task force specifically reviewed evidence supporting primary-care screening, its statement also called for collaborative efforts among mental-health specialists, family physicians and health systems.