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Depressed? New York City Screens for People at Risk
NY Times ^ | April 13, 2005 | MARC SANTORA and BENEDICT CAREY

Posted on 04/16/2005 5:02:26 PM PDT by neverdem

Doctors in New York City have begun to use a simple questionnaire to determine if a patient is at risk for depression, a practice that health officials hope will become a routine part of primary care, much like a blood pressure test or cholesterol reading.

The new program is the first to carry out depression screening using a scored test on a wide scale. It comes amid a spirited national debate among psychiatrists, policy makers and patient-advocacy groups on the wisdom of screening for mental disorders, especially in children.

In 2003, an expert panel convened by President Bush recommended expanding mental health screening, and Congress budgeted $20 million in supporting money for state pilot programs for this year. Several states, including populous states like Florida and Illinois, have begun to investigate large-scale screening plans, and scores of schools and other youth centers throughout the country have used instruments to test youngsters for suicide risk.

But some politicians and advocates for patients argue that testing people broadly for mental conditions is an invitation to overdiagnosis, unnecessary treatment and lifelong stigmatization.

In New York, no federal money is being used for the program, which is under way in hospitals run by the city. The test, which is being given to adults only, derives a depression score from the answers to nine questions. It is not meant to yield a formal diagnosis, but a high score would lead a doctor to recommend a more thorough clinical screening.

The test includes questions about mood and behavior.

For instance, patients are asked if over the past two weeks they have felt "down, depressed or hopeless." They can answer by checking one of four categories: not at all, several days, more than half the days or nearly every day. Dr. Lloyd I. Sederer, who heads the mental health division of the Department of Health and Mental Hygiene, which is leading the New York effort, said he hoped the screening would set an example for other doctors in New York and around the country.

"It is our hope to have this become a standard practice," Dr. Sederer said.

Health officials in New York City are working with the Health and Hospitals Corporation to put their screening program into effect. So far, only about a dozen primary-care physicians are using the test, which was developed using research from the RAND Corporation. The goal is to have every primary-care physician in the city hospital system using the test within the next two or three years. One in every four New Yorkers uses city hospitals for basic health-care treatment, meaning the program could soon involve millions of patients.

Dr. Sederer said that a similar screening test could be developed for adolescents and that if the testing of adults gained acceptance, it would be easier for doctors to use a screening procedure for patients of any age.

Psychiatrists and other proponents say mental health screening is long overdue. They argue that millions of people with serious mental disorders never get help, and that heightened vigilance would not only allow doctors to head off much worse mental problems later, but would also reduce the tremendous costs of untreated illness.

Surveys have found that about 16 percent of Americans - or as many as 46 million people - suffer from depression at some point. And by some estimates, depression costs the nation $44 billion a year in lost work and disability - more than any other illness, including heart disease.

But opponents say that depression is not always easy for primary-care doctors to recognize, even in people who seek help, and they argue that a screening score of any kind could needlessly confuse or worry patients.

"When you label people as having a mental problem, such a label stays with them for their entire lives, whether or not it's accurate," said Vera Hassner Sharav, president of the Alliance for Human Research Protection, a patient-advocacy group that has been campaigning to block screening for mental health.

Critics like Ms. Sharav contend that screening tests will also increase the use of psychiatric drugs, including antidepressants like Zoloft and Prozac, whose use in children and adolescents has recently come under scrutiny by regulators.

Representative Ron Paul, a Texas Republican and a gynecologist, introduced an amendment last fall to block federal financing for screening programs, in part because of worries about overmedicating schoolchildren. The plan was rejected.

"We already have a tremendous number of kids being put on drugs like Ritalin and Prozac," Dr. Paul said, "and I think if these screening programs grow, you're going to see a lot of people pushed into medication programs for behavioral problems."

Dr. Sederer and psychiatrists, psychologists and administrators around the country who favor screening say these concerns are overblown and obscure a much larger problem: a dismissive public attitude toward mental illness.

Bill Emmet, coordinator for the Campaign for Mental Health Reform, a coalition of organizations working to build support for screening and other mental health programs, said: "Are people sometimes misdiagnosed? Of course. But the fact is that there are whole segments of the population that for a variety of reasons are not being diagnosed with problems they do have, and that is the far greater problem."

Dr. Sederer said that once doctors were convinced that a quantitative score worked in recognizing depression, they would be more open to using similar measures for other areas of mental health.

Still, he acknowledged that "nobody likes to be measured" and said that there had been some resistance from doctors who worried that this would take away from already limited time with patients and add to their workload. The science behind screening is mixed. In studies of patients who belong to health maintenance organizations in California and Washington, researchers have found that screening, when combined with programs that coordinate treatment, does help many adults who are struggling with depression and who would otherwise receive little or no care.

But in May, the Preventive Services Task Force, a federal panel of experts that advises doctors and the government on screening guidelines, concluded that there was not enough evidence to recommend a similar kind of screening for suicide risk. The controversy is not likely to be settled soon.

"I have been getting a lot of attention on this, and it runs across the political spectrum, from civil libertarians on the left to Christians on the right," Representative Paul said. "I think the idea of screening people, of asking these kinds of questions, rubs people the wrong way, and particularly when it's their children."

Officials in New York, however, defend their initiative.

"Depression is a leading illness in New York City, but it can be effectively treated," said Dr. Thomas R. Frieden, the city's health commissioner. "Our surveys show that there are an estimated 400,000 New Yorkers with depression; many have not been accurately diagnosed or effectively treated."


TOPICS: Culture/Society; Front Page News; Government; News/Current Events
KEYWORDS: bang; banglist; depression; health; medicine; mentaldisorders; mentalhealth; newyorkcity
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To: goldstategop

Whew! That article's depressing!


21 posted on 04/16/2005 6:25:56 PM PDT by bannie (The government which robs Peter to pay Paul can always depend upon the support of Paul.)
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To: neverdem

Funny, when I lived in NYC, I was only depressed when I was a poor student looking for work. Now I am gainfully employed, with a good paying job, living in the "hippest nabe in Seattle" and I am depressed as all hell.


22 posted on 04/16/2005 6:35:26 PM PDT by Clemenza (Alcohol Tobacco & Firearms: The Other Holy Trinity)
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To: neverdem
Fred R. Conrad/The New York Times

Dr. Lloyd I. Sederer, the director of mental health services in New York, hopes to set an example for the nation by screening for depression.

The New York Times could set an example and give that test to their entire staff -- and in that way, qualify their current staff for disability and hire a whole bunch of bright, cheerful, optimistic, fair and balanced people.

23 posted on 04/16/2005 6:53:37 PM PDT by MikeHu
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To: COUNTrecount

NYkers are not depressed, they are NUTS!
Proof: they elected Chucky and Hitlery!
Freeeepy!


24 posted on 04/16/2005 7:29:43 PM PDT by Leo Carpathian (FReeeePeee!)
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To: Mulder

I thought some states had passed laws doing just that.


25 posted on 04/16/2005 7:32:46 PM PDT by Pan_Yans Wife (" It is not true that life is one damn thing after another-it's one damn thing over and over." ESV)
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To: neverdem
Psychiatrists and other proponents say mental health screening is long overdue their patient load has dropped dramatically. They argue that millions of people with serious any mental disorders never get help, and that heightened vigilance would not only allow doctors to head off much worse mental problems later, but would also reduce the tremendous costs of untreated illness fatten the wallets of mental healh care providers.
26 posted on 04/16/2005 7:37:18 PM PDT by DumpsterDiver
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To: DumpsterDiver

Your username is DUMPSTERDIVER,
You must have a mental illness. Please call your DR. in the morning for a prescription to cure you of dumpsterdiving. :)


27 posted on 04/16/2005 11:54:29 PM PDT by 1FASTGLOCK45 (FreeRepublic: More fun than watching Dem'Rats drown like Turkeys in the rain! ! !)
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To: neverdem

I wouldn't tell the truth on one of those stupidd things even if I WAS depressed.... if I wold want help for something like that, I would chose WHEN and to WHOM to seek help....
no thanks, Nanny, but I can manage!


28 posted on 04/17/2005 12:24:53 AM PDT by Conservatrix (He who stands for nothing will fall for anything.)
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To: 1FASTGLOCK45
Your username is DUMPSTERDIVER,
You must have a mental illness. Please call your DR. in the morning for a prescription to cure you of dumpsterdiving. :)

I only took up dumpster diving after my psychiatrist suggested it as a way to save money while we worked on curing my "problem" of being a shopaholic.

Why must I be so relentlessly persecuted!!!! :-)

29 posted on 04/17/2005 7:18:23 AM PDT by DumpsterDiver
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To: All
Gee, guys. Glad you find this subject so funny. For those of us who have lived through years of this, serious hospital treatment including electro-convulsive therapy, multiple prescription trials, multiple hospital admissions, lost employment, etc. it is not so funny. I wish someone had screened me earlier for diagnosis, and for heavens sakes I am a registered nurse!

BTW, psychiatrists should be in charge of medication management, especially for children, not the family doctor.

They are the experts. My internist won't touch that subject.
30 posted on 04/17/2005 7:35:51 AM PDT by Goodgirlinred ( GoodGirlInRed Four More Years!!!!!)
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To: Goodgirlinred
I'm sorry to hear of your troubles. I for one don't think it's funny at all... The problem with this screening tool, is that it is possible for MDs to prescribe heavy-duty anti-depressants to people WITHOUT requiring any type of counseling. This "screening" while it may help some people who have GOOD doctors who are well-educated in these areas, could be a very bad thing for people who have MDs that already over-prescribe these medications without added support (the MDs could see this as a complete diagnostic tool that gives them a green light to prescribe).

As a nurse, and someone who unfortunately has first hand knowledge on this subject I'm sure you understand what I mean when I say this could be dangerous...
31 posted on 04/17/2005 9:14:31 AM PDT by LibertyRocks
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To: inquest
"Schools are already doing it to kids."

You're right about that too! I can't believe the number of children nowadays that attend school drugged up... I don't recall that many kids I went to school with needing so much medication. I don't think society has changed THAT much, but their ideas (teachers, psychologists) on treating children with problems certainly has... The scariest thing is what happens to these children when they grow up, lose their parents health insurance, but are addicted to these mood-altering chemicals, and then have no experience in controlling their behavior without assistance from the drugs themselves? Childhood is about learning - behavior included... I'm not saying there are not ANY kids who are helped by these medicines, but it seems that nowadays ANY deviation from "normal" behavior warrants a visit to a psychiatrist for medication. [I've even heard of school officials (not doctors) requiring medication or the child not being able to attend classes with that decision made BEFORE the child has even seen a doctor or been diagnosed with a medication requiring illness! Many teachers and administrators are taking it upon themselves to diagnose these children - they are teachers, not doctors and this practice should be stopped!]
32 posted on 04/17/2005 9:24:41 AM PDT by LibertyRocks
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To: LibertyRocks

"medication requiring illness" = illness requiring medication... (o:


33 posted on 04/17/2005 9:26:46 AM PDT by LibertyRocks
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To: inquest

Do you know how much money is in it for them to say you got a problem?


34 posted on 04/17/2005 9:44:24 AM PDT by Almondjoy
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To: LibertyRocks

Of course I do. This is merely a tool, not a substitute for good sound medical practice. It should be used as a flag only to give the doctor a heads up that this patient MAY have a problem with depression. Then he can do a further in-depth work up with a referral to a therapist and possibly then a prescription for medication or referral to a psychiatrist.


35 posted on 04/17/2005 10:34:16 AM PDT by Goodgirlinred ( GoodGirlInRed Four More Years!!!!!)
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To: LibertyRocks
It also has gotten to the point where parents have been accused by officials of child abuse or neglect if they refuse to allow their kids to take medications that a teacher or principal "prescribed".
36 posted on 04/17/2005 10:54:56 AM PDT by inquest (FTAA delenda est)
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To: Almondjoy
No I don't.
37 posted on 04/17/2005 10:55:45 AM PDT by inquest (FTAA delenda est)
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To: Goodgirlinred
What do you think of that questionnaire posted on the thread right below the article? Do you think, for example, that the third or fourth item should rank the same number of points as the ninth?
38 posted on 04/17/2005 10:58:36 AM PDT by inquest (FTAA delenda est)
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