Case-finding for depression among medical outpatients in the Veterans Health Administration

Med Care. 2006 Feb;44(2):175-81. doi: 10.1097/01.mlr.0000196962.97345.21.


Objectives: We sought to determine the rates and predictors of screening, screening positive, follow-up evaluation, and subsequent diagnosis of depression among medical outpatients.

Research design: This was a cross-sectional study using chart-review data from the Department of Veterans Affairs (VA) 2002 External Peer Review Program merged with administrative data.

Subjects and measures: We studied a national sample of VA medical outpatients with no depression diagnosis or mental health visits in the past 6 months (n = 21,489) and used chart-review and administrative data to follow the chain of events from depression screening to diagnosis.

Results: Overall, 84.9% of eligible patients (n = 18,245) were screened for depression in the past year. Of the 8.8% who screened positive, only 54.0% received follow-up evaluation and, of these, 23.6% (n = 204) subsequently were diagnosed with a depressive disorder (representing 1.1% of the originally screened sample). Patients who were younger, unmarried, and had more medical comorbidities were less likely to be screened; however, if screened, they were more likely to screen positive. Male gender and greater medical comorbidity were associated with decreased odds of follow-up evaluation after a positive screen. At the facility level, likelihood of depression screening was inversely associated with spending on teaching and research but positively associated with spending on mental health care.

Conclusions: VA's depression case-finding activities yielded relatively few positive cases, raising questions about cost-effectiveness. Targeted strategies may increase the value of case-finding among patients at greatest risk for depression and at more academically affiliated medical centers. Targeted efforts also are needed to ensure proper follow-up evaluation of suspected cases, particularly among male patients and those with increased medical comorbidity.

Publication types

  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Academic Medical Centers / economics
  • Academic Medical Centers / organization & administration
  • Adult
  • Aged
  • Cross-Sectional Studies
  • Depression / diagnosis*
  • Female
  • Hospitals, Veterans / economics
  • Hospitals, Veterans / organization & administration
  • Humans
  • Male
  • Medical Records
  • Middle Aged
  • Outpatients*
  • Risk Factors
  • Socioeconomic Factors
  • United States
  • United States Department of Veterans Affairs*