title: Missed opportunities for depression screening in patients with arthritis in the United States.
abstract: BACKGROUND
  Arthritis affects 20 % of the adult US population and is associated with comorbid depression. Depression screening guidelines have been endorsed for high-risk groups, including persons with arthritis, in the hopes that screening will increase recognition and use of appropriate interventions.
  
  
  OBJECTIVE
  To examine national rates of depression and depression screening for patients with arthritis between 2006 and 2010.
  
  
  METHODS
  We used nationally representative cross-sections of ambulatory visits in the United States from the National Ambulatory Medical Care Survey from 2006 to 2010, which included 18,507 visits with a diagnosis of arthritis. When weighted to the US population, this total represents approximately 644 million visits.
  
  
  METHODS
  Visits where arthritis was listed among diagnoses. Outcomes were survey-weighted estimates of depression and prevalence of depression screening among patients with arthritis across patient and physician characteristics.
  
  
  RESULTS
  Of the 644,419,374 visits with arthritis listed, 83,574,127 (13 %) were associated with a comorbid diagnosis of depression. The odds ratio for comorbid depression with arthritis was 1.42 (95 % CI 1.3, 1.5). Depression screening occurred at 3,835,000 (1 %) visits associated with arthritis. When examining the rates of depression screening between ambulatory visits with and without arthritis listed, there was no difference in depression screening rates; both were approximately 1 %. There was no difference in screening rates by provider type. Compared to visits with other common, chronic conditions, the prevalence of depression at arthritis visits was high (13 per 100 visits), although the prevalence of depression screening at arthritis visits was low (0.68 per 100 visits).
  
  
  CONCLUSIONS
  Despite the high prevalence of depression with arthritis, screening for depression was performed at few arthritis visits, representing missed opportunities to detect a common, serious comorbidity. Improved depression screening by providers would identify affected patients, and may lead to appropriate interventions such as mental health referrals and/or treatment with anti-depressants.
authors.affiliation: Division of Rheumatology, Department of Medicine, University of California San Francisco, San Francisco, CA, USA, Mary.margaretten@ucsf.edu.
authors.forename: Mary E
authors.initials: ME
authors.lastname: Margaretten
authors.forename: Patricia
authors.initials: P
authors.lastname: Katz
authors.forename: Gabriela
authors.initials: G
authors.lastname: Schmajuk
authors.forename: Edward
authors.initials: E
authors.lastname: Yelin
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000553:Ambulatory Care / Q000379:methods* / Q000592:standards; D001168:Arthritis / Q000453:epidemiology* / Q000628:therapy*; D003430:Cross-Sectional Studies; D003863:Depression / Q000175:diagnosis* / Q000453:epidemiology* / Q000628:therapy; D005260:Female; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000379:methods* / Q000592:standards; D008875:Middle Aged; D009819:Office Visits; D014481:United States / Q000453:epidemiology; D055815:Young Adult
references.citation: Arthritis Care Res (Hoboken). 2011 Oct;63(10):1382-90
references.pmid: 20662042
references.citation: Psychosom Med. 2002 Jan-Feb;64(1):52-60
references.pmid: 11818586
references.citation: Arthritis Rheum. 2009 Jul 15;61(7):944-50
references.pmid: 19565540
references.citation: Arthritis Rheum. 2008 Feb 15;59(2):186-91
references.pmid: 18240190
references.citation: Clin Exp Rheumatol. 2008 Sep-Oct;26(5 Suppl 51):S120-4
references.pmid: 19026154
references.citation: J Gen Intern Med. 2006 Nov;21(11):1160-6
references.pmid: 16879706
references.citation: J Rheumatol. 2010 Oct;37(10):2021-4
references.pmid: 20682674
references.citation: Rheumatology (Oxford). 2003 Feb;42(2):287-91
references.pmid: 12595624
references.citation: Natl Health Stat Report. 2010 Nov 3;(27):1-32
references.pmid: 21089986
references.citation: J Rheumatol. 1997 Jan;24(1):169-73
references.pmid: 9002029
references.citation: J Rheumatol. 2007 Jul;34(7):1475-9
references.pmid: 17552045
references.citation: Ann Intern Med. 2009 Dec 1;151(11):784-92
references.pmid: 19949144
references.citation: Prev Chronic Dis. 2010 May;7(3):A64
references.pmid: 20394703
references.citation: Arch Intern Med. 2005 Jun 13;165(11):1260-6
references.pmid: 15956005
references.citation: JAMA. 1999 Nov 10;282(18):1737-44
references.pmid: 10568646
references.citation: J Rheumatol. 2005 Jun;32(6):1013-9
references.pmid: 15940760
references.citation: J Occup Environ Med. 2008 Apr;50(4):459-67
references.pmid: 18404019
references.citation: Psychiatr Serv. 2010 Feb;61(2):151-9
references.pmid: 20123820
references.citation: CMAJ. 2005 Jan 4;172(1):33-5
references.pmid: 15632399
references.citation: J Am Geriatr Soc. 2003 May;51(5):636-41
references.pmid: 12752838
references.citation: BMC Psychiatry. 2011 Sep 12;11:147
references.pmid: 21910895
references.citation: Am J Prev Med. 2006 Jul;31(1):52-61
references.pmid: 16777543
references.citation: Gen Hosp Psychiatry. 2009 Jul-Aug;31(4):353-9
references.pmid: 19555796
references.citation: Med Care. 2004 Mar;42(3):276-80
references.pmid: 15076827
references.citation: Rheumatology (Oxford). 2005 Feb;44(2):241-6
references.pmid: 15522922
references.citation: Arthritis Care Res (Hoboken). 2012 Jul;64(7):968-76
references.pmid: 22550055
references.citation: J Rheumatol. 2008 Feb;35(2):335-42
references.pmid: 18203312
references.citation: Natl Health Stat Report. 2008 Aug 6;(3):1-39
references.pmid: 18972720
references.citation: Adv Data. 2007 Jun 29;(389):1-34
references.pmid: 17784724
references.citation: Int J Clin Rheumtol. 2011;6(6):617-623
references.pmid: 22211138
references.citation: Rheumatol Int. 2007 Jul;27(9):859-63
references.pmid: 17242902
references.citation: Arthritis Rheum. 2007 May;56(5):1397-407
references.pmid: 17469096
references.citation: Arthritis Rheum. 2006 Jan;54(1):226-9
references.pmid: 16385518
references.citation: Bol Oficina Sanit Panam. 1968 Oct;65(4):281-393
references.pmid: 4234760
references.citation: Arthritis Rheum. 2002 Dec 15;47(6):571-81
references.pmid: 12522829
references.citation: Ment Health Fam Med. 2010 Jun;7(2):107-13
references.pmid: 22477929
references.citation: Osteoarthritis Cartilage. 2010 Feb;18(2):160-7
references.pmid: 19825498
references.citation: Arch Intern Med. 2000 Jul 24;160(14):2101-7
references.pmid: 10904452
references.citation: Ann Intern Med. 2002 May 21;136(10):765-76
references.pmid: 12020146
references.citation: Med Care. 2010 Sep;48(9):785-91
references.pmid: 20706165
references.citation: J Gen Intern Med. 1997 Jul;12(7):439-45
references.pmid: 9229283
references.citation: Arthritis Rheum. 2003 Apr 15;49(2):164-71
references.pmid: 12687506
references.citation: Baillieres Best Pract Res Clin Rheumatol. 2000 Dec;14(4):773-86
references.pmid: 11092801
references.citation: Arthritis Rheum. 2007 Apr 15;57(3):415-22
references.pmid: 17394226
references.citation: Arthritis Care Res (Hoboken). 2011 Sep;63(9):1238-46
references.pmid: 21671414