title: Telephonic case-finding of major depression in a Medicaid chronic disease management program for diabetes and heart failure.
abstract: 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.
authors.affiliation: Department of Medicine, Indiana University School of Medicine, Indianapolis, IN 46202, USA. rtackerm@iupui.edu
authors.forename: Ronald T
authors.initials: RT
authors.lastname: Ackermann
authors.forename: Marc B
authors.initials: MB
authors.lastname: Rosenman
authors.forename: Stephen M
authors.initials: SM
authors.lastname: Downs
authors.forename: Ann M
authors.initials: AM
authors.lastname: Holmes
authors.forename: Barry P
authors.initials: BP
authors.lastname: Katz
authors.forename: Jingjin
authors.initials: J
authors.lastname: Li
authors.forename: Alan J
authors.initials: AJ
authors.lastname: Zillich
authors.forename: Caroline P
authors.initials: CP
authors.lastname: Carney
authors.forename: Thomas S
authors.initials: TS
authors.lastname: Inui
mesh_terms: 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
chemical_list: D000928:Antidepressive Agents