Why is my doctor’s assistant asking if I am anxious or depressed? | Expert Opinion

Periodically, one of my patients asks me why our medical assistants ask about symptoms of anxiety and depression while checking vital signs.

“I’m just here to follow up on my diabetes and high blood pressure. Why so much concern about my mental health?”

The simplest answer is that these screening questions can be lifesaving. Major depression — a persistently depressed mood and long-term loss of pleasure in activities — is extremely common, affecting around 8% of people over age 12 in the United States. Untreated, it can significantly increase risk of suicide.

Many more people experience at least one symptom of depression, such as sadness or hopelessness, loss of appetite, disordered sleep, social isolation, and cognitive impairment.

Depression can affect people’s work performance and personal relationships, and increases their risk for substance use disorder. Further, they may struggle to adhere to prescribed treatment for other chronic health conditions, as well as recommended preventive care, risking further health decline.

Depression screening usually consists of a two-question survey called a PHQ-2 (Personal Health Questionnaire), which asks how often you feel little interest or pleasure in doing things, and how often you feel down, depressed or hopeless.

Patients respond by selecting a number: 0, not at all; 1, several days; 2, more than half of days; or 3, every day.

A score of three or more highly suggests major depression. A positive PHQ-2 screen may then lead to a more specific screening survey such as PHQ-9 or a Geriatric Depression Scale.

The U.S. Preventive Services Task Force (USPSTF) now also recommends screening for anxiety in all patients aged 7 through 65. Like depression, anxiety can be disabling and under recognition limits access to highly effective treatments.

In the event of a positive depression or anxiety screening, the medical assistant who screened you would communicate this to your primary care clinician with whom you can review further details and treatment options. As with many other elements of preventive care, the idea is to help preserve time with your clinician for meaningful discussion.

If you are not experiencing anxiety or depression, this process may seem irrelevant. Team-based screening seeks to preserve one-on-one clinician time to address your principal concerns. However, if you are one of the millions who struggle without a pathway to explore your emotional concerns, screening may be the key to opening a door that’s been locked far too long.

Jeffrey Millstein is an internist and regional medical director for Penn Primary Care.