Mental Health Services during the Pandemic

Introduction: Whether routine screening for depression among patients in primary care medicine improves identification and treatment of the disorder remains unclear. We conducted a systematic review of the literature to address the following questions specific to this population: 1) how well do screening tools detect depression?, 2) does screening lead to diagnosis, treatment, and improved outcomes?, and 3) analyze our performance in screening and treating mental health conditions during the pandemic in order to increase the rate of clinical improvement in depression scores from 16% in January 2020 to 66% by December 2020.

Methods: We searched bibliographic databases for full-length articles published in English around COVID pandemic from January 2020 to December 2020 and articles from previous years on depression in primary care settings and completed a review of our own primary care patients screened and treated during this time.

Results: Screening process amongst out patient population has improved the patient’s receipt of diagnosis and treatment. Effective treatments include exercise, psychotherapy, and pharmacotherapy.

Discussion: The coronavirus disease 2019 (COVID-19) pandemic has been associated with mental health challenges related to the morbidity and mortality caused by the disease and to mitigation activities, including the impact of physical distancing and stay-at-home orders. To assess mental health and suicidal ideation during the pandemic, representative panel surveys were conducted among adults aged ≥18 years. The pandemic interrupted routine screening and in-office visits. Retraining of staff/providers was needed to complete PHQ2/9 during video visits.

Analysis were stratified based on primary drivers like depression screens, documentation and patient engagement, and our secondary drivers like workflow and process improvement consistent documentation of PHQ9 screening and increase patient attendance to therapy appointments. We were able to accomplish this, and mitigate activities around staff and provider trainings to complete telephonic visits that led to high-connection rate, workflow review at huddles to reinforce paper screening alongside with electronic data entry, electronic screenings utilizing Epic flowsheets and co-location of therapist-collaborative care therapist in primary care. This improved our access to trained staff for referrals and discussions at team meetings with psychiatrist for consultation and then recommendation to start medication as needed.

References
1) Williams JW Jr, Pignone M, Ramirez G, Perez Stellato C. Identifying depression in primary care: a literature synthesis of case-finding instruments. Gen Hosp Psychiatry 2002;24(4):225-37.
2) Mark É. Czeisler, Rashon I. Lane, MA, Emiko Petrosky, MD, Joshua F. Wiley, PhD, Aleta Christensen, MPH, Rashid Njai, Matthew D. Weaver, PhD, Rebecca Robbins, PhD, Elise R. Facer-Childs, PhD, Laura K. Barger, PhD, Charles A. Czeisler, MD, PhD, Mark E. Howard, MBBS, PhD, Shantha M.W. Rajaratnam, PhD Mental Health, Substance Use, and Suicidal Ideation During the COVID-19 Pandemic — United States, June 24–30, 2020 Weekly / August 14, 2020 / 69(32);1049–1057