Over three decades of work in the development of depression diagnostic tools: How are they used now?

Depression is a highly prevalent, disabling public health condition in the US, and more than half of people with mental health issues receive care from primary care (PC) clinicians. Despite decades of research, there remains a gap between idealized care for depression and actual outcomes in PC settings. One strategy for enhancing management has been the development of depression diagnostic tools to help diagnose, stratify the severity, and follow the treatment of depression. To our knowledge, our NIH funded project (DEED) is the first to investigate naturalistically how PC clinicians use depression tools in actual community practice. From our in-depth interviews (50-70minutes) with fifty-three PC clinicians (20 family physicians, 21 general internists, and 12 nurse practitioners, of diverse ethnicity) from 38 PC offices, we found that they did not routinely incorporate depression tools to aid in either the recognition or management of depression. Rather, they used depression tools to enhance skeptical patients' acceptance of the diagnosis of depression and to negotiate a common goal for initiating the treatment. Three real-world practice conditions influenced their use or non-use of the tools: competing demands for the clinician's time, the absence of confirmatory tests for depression, and the clinician's familiarity with the patient. The clinicians, collectively, agreed that their routine use of depression tools would not fit in their everyday practice environment where they have to deal with multiple issues in relatively short visits. Our findings warrant the investigation of real-world practice contexts in order to strategically aid PC clinicians' treatment of depression.