Screening and Assessing Depression in Primary Care Settings: Clinical and Ethical Considerations

Internet Enduring Material Sponsored by the Stanford University School of Medicine. Presented by the Department of Psychiatry and Behavioral Sciences at the Stanford University School of Medicine.

This CME activity focuses on depression in the primary care setting – the screening, assessment, and referral of depressed patients. Guidance is given for effective referral of depressed patients to psychiatry treatment and interfacing with mental health providers and systems. Learners are engaged by didactic videos with animations, short modules with role-play demonstrations of patients and physicians, case studies and self-assessments.

This course is designed for family practice doctors, primary care physicians, internal medicine physicians, OB/GYNs providing primary care, and allied health professionals providing care in primary care settings.

• Release Date: October 2, 2015
• Expiration Date: August 31, 2018
• Estimated Time to Complete: 1.5 Hours
• CME Credits Offered: 1.50
• Registration Fee: $25

• Review the information below and complete the entire activity.
• Complete the CME Post-test, CME Evaluation Survey, and CME Activity Completion Statement at the end of the activity.
• You must receive a score of 75% or higher on the post-test in order to receive a certificate. You will have two attempts to answer each multiple-choice question (or one attempt for questions with only two options) to pass the post-test.
• Once you attest to completing the entire online activity and have scored 75% or higher on the post-test, your certificate will be generated automatically and will be available on your Dashboard page.
• Physicians will be awarded AMA PRA Category 1 Credits™. All other participants will receive a Certificate of Participation.

At the conclusion of this activity, participants should be able to:

• Describe the clinical diagnosis of depression and impact of misdiagnosis or missed diagnosis.
• Recognize identifying signs and symptoms of the range of patient presentation of depression in the primary care setting.
• Screen patients for depression and suicide risk in a primary care setting.
• Assess the severity of depression and suicide risk, in the time limits of a primary care visit, using the DSM-5 criteria for depressive disorder.
• Implement an effective referral process of depressed and/or suicidal patients to psychiatric treatment.
• Manage long-term treatment for depressed patients through coordinated care with mental health providers and systems.

1. Introduction
2. Overview of Depression in Primary Care Settings
3. Co-morbidity of Depression and Medical Illness
4. Screening for and Assessing Depression
5. Depression and Co-morbidity with Anxiety and Substance Abuse
6. Mental Health Referrals
7. Course Wrap-up
8. Resources and References
9. Help!

The following planners, speakers and authors have indicated that they have no relationships with industry to disclose relative to the content of this activity:

Oxana Palesh, PhD
Assistant Professor of Psychiatry and Behavioral Sciences
Director of Stanford Cancer Survivorship Research
Stanford University School of Medicine
Course Director

Cheryl Gore-Felton, PhD
Professor & Associate Chairman of Psychiatry and Behavioral Sciences, Associate Dean for Academic Affairs
Stanford University School of Medicine
Course Director

Alan K. Louie, MD
Professor (Teaching) of Psychiatry and Behavioral Science
Stanford University School of Medicine
Planner

Laura W. Roberts, MD, MA
Chair & Professor of the Department of Psychiatry and Behavioral Sciences
Stanford University School of Medicine
Planner

Melissa Packer, MA
Project Coordinator
Psych/Public Mental Health & Population Sciences
Stanford University School of Medicine
Planner

Mary Ann Norfleet, PhD
Adjunct Clinical Instructor
Psychiatry and Behavioral Sciences
Stanford University School of Medicine
Planner

Stephaine Evans, PhD
Adjunct Clinical Instructor
Psychiatry and Behavioral Sciences
Stanford University School of Medicine
Planner

Ellen Hendriksen, PhD
Clinical Assistant Professor of Psychiatry and Behavioral Sciences
Stanford University School of Medicine
Planner
Speaker

David Spiegel, MD
Wilson Professor and Associate Chair
Psychiatry and Behavioral Science
Stanford University School of Medicine
Speaker

Rex Huang, MD
Chief of the Division of Child and Adolescent Psychiatry
Assistant Chief of the Department of Psychiatry
Kaiser Permanente San Jose Medical Center
Author

Helen Wilson, PhD
Clinical Assistant Professor of Psychiatry and Behavioral Science
Stanford University School of Medicine
Author

Mike McAuliffe
Stanford EdTech

Kimberly Walker, PhD
Stanford EdTech

Greg Bruhns
Stanford Online

Role Play Actors

• Computer with Internet connection
• Current version of Chrome, Firefox or Safari browser
• You must have javascript enabled

The Stanford University School of Medicine is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

The Stanford University School of Medicine designates this enduring material for a maximum of 1.50 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

This activity received no commercial support.

California Assembly Bill 1195 requires continuing medical education activities with patient care components to include curriculum in the subjects of cultural and linguistic competency. It is the intent of the bill, which went into effect July 1, 2006, to encourage physicians and surgeons, CME providers in the State of California and the Accreditation Council for Continuing Medical Education to meet the cultural and linguistic concerns of a diverse patient population through appropriate professional development. The planners and speakers of this CME activity have been encouraged to address cultural issues relevant to their topic area. The Stanford University School of Medicine Multicultural Health Portal also contains many useful cultural and linguistic competency tools including culture guides, language access information and pertinent state and federal laws.

You are encouraged to visit the portal: http://lane.stanford.edu/portals/cultural.html

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If you are having technical problems (video freezes or is unplayable, can't print your certificate, etc.) you can submit a Help Request to the OpenEdX Team. If you have questions related to CME credit, requirements (Pre-test, Post-test, Evaluation, Attestation) or course content, you can contact the CME Online support team at cmeonline@stanford.edu.

Culpepper, L. Managing depression in primary care: achieving remission. Primary Care Companion Journal of Clinical Psychiatry. 2006;8(2):88-97.

Hegarty K, Gunn J, Blashki G, Griffiths F, Dowell T, Kendrick T. How could depression guidelines be made more relevant and applicable to primary care? A quantitative and qualitative review of national guidelines. Br J Gen Pract. 2009;59(562):e149-56.

Luoma JB, Martin CE, Person JL. Contact with mental health and primary care providers before suicide: a review of the evidence. Am J Psychiatry. 2002;159(6):909-916.

Mitchell J, Trangle M, Degnan B, et al. Institute for Clinical Systems Improvement. Adult Depression in Primary Care. 16th Ed, September 2013. See https://www.icsi.org/_asset/fnhdm3/Depr-Interactive0512b.pdf

O'Connor EA, Whitlock EP, Beil TL, Gaynes BN. Screening for depression in adult patients in primary care settings: a systematic evidence review. Ann Intern Med. 2009;151(11):793-803.

Pirkis J, Burgess P. Suicide and recency of health care contacts. A systematic review. Br J Psychiatry. 1998;173:462-474.

Pignone MP, Gaynes BN, Rushton JL, et al. Screening for depression in adults:a summary of the evidence for the U.S. Preventive Services Task Force. Ann Intern Med. 2002;136(10):765-776.