Depression and Therapy Outcomes

Depression: The Silent Roadblock

According to the National Institutes of Health, nearly 19 million American adults suffer from depressive disorders—that’s close to ten percent of the U.S. adult population. And in 2001, the World Health Organization said in a report that by the year 2020, depression will be the second largest killer after heart disease. Today more than ever, understanding depressive disorders and their effect on the well-being of our patients is imperative for healthcare professionals.

The Link between Depression and Therapy Outcomes

The journal "Physical Therapy" recently published findings from a study which sought to determine the impact of depressive symptoms for patients with musculoskeletal pain across different anatomical regions. Researchers collected data from more than 8,300 patients and considered factors such as pain intensity and functional status in an effort to see how depression can influence clinical outcomes.

In patients who reported chronic pain or had recently undergone surgery, the prevalence of severe depression was higher, and in nearly all anatomical regions depressive symptoms significantly affected pain intensity and functional status. In their conclusion, researchers stated that depressive symptoms had “a consistent detrimental influence on outcomes” and went on to suggest the following: “Expanding screening recommendations for depressive symptoms to include more anatomical regions may be indicated in physical therapy settings.”
 

The Role of the Screening Process

Although efforts have been made to standardize tests and screening tools to accurately diagnose depression, it is important to remember there is no one solution that fits every patient. The screening tool does not diagnose depression; rather, it helps in identifying at-risk patients who may benefit from preventive efforts and management of symptoms.

In addition to the use of screening tools, it is equally important to rely on observation and information. Clues that may identify depression include any change in the patient’s behavior or appearance. Feedback from family and other care providers is vital, as they are more likely to notice subtle changes in mood or behavior. It is important to involve caregivers and family members in the screening process, as this adds consistency and clarity to the evaluation of depression.

Depression Screening Tools

Many tools exist to help healthcare professionals identify at-risk patients, and therapists should have a good knowledge of each. The following is a brief overview of some of the more common screening methods which may be used.

• Patient Health Questionnaire (PHQ) This multiple choice questionnaire is a simple and effective tool for screening and, if depression is suspected, helping to further quantify the severity of depression. PHQ-9 looks specifically at depression, and scoring is based on the mood module of the Primary Care Evaluation of Mental Disorders (PRIME-MD). PHQ-2 is a shorter version of PHQ-9.
   
• Zung Self-Rating Depression Scale (ZDS) This is a 20-question self-rating assessment for depression that is widely used for adult depression screening. The ZDS is also an effective outcome measurement tool for tracking a client's progress with therapy over time.
   
• Hamilton Depression Rating Scale (HAM-D) A 21-item screening instrument designed to measure the severity of illness in adults already diagnosed as having depression, the HAM-D is widely used for measuring outcome in mood disorders and offers high validity and reliability in measuring response to treatment.  
   
• Mini-Mental State Exam (MMSE) Especially helpful for elderly patients, the MMSE is a widely used cognitive functioning assessment that screens for dementia and is used as a preliminary step in detecting depression in patients who have dementia. It should be coupled with other screening tools when evaluating for depression in elderly patients because it relies heavily on verbal, reading, and writing responses. 
   

Conclusion

With depressive disorders on the rise in the U.S., we are likely to see more studies like the one published in "Physical Therapy". Because gaining a better understanding of depressive symptoms and their role in patient recovery could be the key to ensuring optimal patient outcomes, therapists and other care providers should stay abreast of the latest advancements in depression diagnosis and treatment.

To learn more about depression, screening methods, and the effects of depressive symptoms on patient recovery, view our comprehensive continuing education course library.

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