Telephonic case-finding of major depression in a Medicaid chronic disease management program for diabetes and heart failure.
OBJECTIVE
Major depression is common in low-income and chronically ill persons and is a barrier for effective chronic disease care. We evaluated a Medicaid-sponsored strategy for detecting depressive symptoms in adults with diabetes or congestive heart failure.


METHODS
Using a two-item screening tool, 890 adults enrolled in the Indiana Chronic Disease Management Program were assessed by telephone for depressive symptoms between December 2003 and March 2004. A subset of 386 participants also completed the eight-item Patient Health Questionnaire (PHQ-8) depression measure. Antidepressant use was examined using pharmacy claims.


RESULTS
Depressed mood or anhedonia was reported by 51% of participants. About one in four participants had a PHQ-8 score indicating a high risk for major depression (score >or=10). The two-item screen was 96% sensitive [95% confidence interval (CI), 89-99%] and 60% specific (95% CI, 54-65%) for identifying members at high risk for depression by the full PHQ-8 instrument. Only half of participants with high-risk PHQ-8 scores had a pharmacy claim indicating that an antidepressant medication was filled within 120 days of the depression screening.


CONCLUSIONS
A two-stage, telephonic approach involving the PHQ-8 instrument for Medicaid members with either depressed mood or anhedonia could identify two clinically depressed persons for every nine members screened.
Ackermann
Ronald T
RT
Department of Medicine, Indiana University School of Medicine, Indianapolis, IN 46202, USA. rtackerm@iupui.edu
Rosenman
Marc B
MB
Downs
Stephen M
SM
Holmes
Ann M
AM
Katz
Barry P
BP
Li
Jingjin
J
Zillich
Alan J
AJ
Carney
Caroline P
CP
Inui
Thomas S
TS
D000928:Antidepressive Agents / Q000627:therapeutic use; D002908:Chronic Disease; D003863:Depression / Q000453:epidemiology*; D003920:Diabetes Mellitus / Q000523:psychology*; D019468:Disease Management; D006333:Heart Failure / Q000523:psychology*; D006801:Humans; D007196:Indiana / Q000453:epidemiology; D008484:Medicaid; D011795:Surveys and Questionnaires; D013689:Telephone
D000928:Antidepressive Agents