Improving Parkinson's Disease Care through Systematic Screening for Depression.
Parkinson's disease
depression
mental health
screening
Journal
Movement disorders clinical practice
ISSN: 2330-1619
Titre abrégé: Mov Disord Clin Pract
Pays: United States
ID NLM: 101630279
Informations de publication
Date de publication:
19 Jul 2024
19 Jul 2024
Historique:
revised:
24
04
2024
received:
03
01
2024
accepted:
01
06
2024
medline:
20
7
2024
pubmed:
20
7
2024
entrez:
20
7
2024
Statut:
aheadofprint
Résumé
Depression is common in Parkinson's disease (PD) but is underrecognized clinically. Although systematic screening is a recommended strategy to improve depression recognition in primary care practice, it has not been widely used in PD care. The 15-item Geriatric Depression Scale (GDS-15) was implemented at 5 movement disorders clinics to screen PD patients. Sites developed processes suited to their clinical workflow. Qualitative interviews with clinicians and patients provided information on feasibility, acceptability, and perceived utility. Prior to implementation, depression screening was recorded in 12% using a formal instrument; 64% were screened informally by clinical interview, and no screening was recorded in 24%. Of 1406 patients seen for follow-up care during the implementation period, 88% were screened, 59% using the GDS-15 (self-administered in 51% and interviewer administered in 8%), a nearly 5-fold increase in formal screening. Lack of clinician or staff time and inability to provide the GDS-15 to the patient ahead of the visit were the most commonly cited reasons for lack of screening using the GDS-15; 378 (45%) patients completing the GDS-15 screened positive for depression, and 137 were enrolled for a 12-month prospective follow-up. Mean GDS-15 scores improved from 8.8 to 7.0 (P < 0.0001) and the 39-item Parkinson's Disease Questionnaire emotional subscore from 42.2 to 36.7 (P = 0.0007). Depression screening in PD using a formal instrument can be achieved at much higher levels than is currently practiced, but there are barriers to implementing this in clinical practice. An individual site-specific process is necessary to optimize screening rates.
Sections du résumé
BACKGROUND
BACKGROUND
Depression is common in Parkinson's disease (PD) but is underrecognized clinically. Although systematic screening is a recommended strategy to improve depression recognition in primary care practice, it has not been widely used in PD care.
METHODS
METHODS
The 15-item Geriatric Depression Scale (GDS-15) was implemented at 5 movement disorders clinics to screen PD patients. Sites developed processes suited to their clinical workflow. Qualitative interviews with clinicians and patients provided information on feasibility, acceptability, and perceived utility.
RESULTS
RESULTS
Prior to implementation, depression screening was recorded in 12% using a formal instrument; 64% were screened informally by clinical interview, and no screening was recorded in 24%. Of 1406 patients seen for follow-up care during the implementation period, 88% were screened, 59% using the GDS-15 (self-administered in 51% and interviewer administered in 8%), a nearly 5-fold increase in formal screening. Lack of clinician or staff time and inability to provide the GDS-15 to the patient ahead of the visit were the most commonly cited reasons for lack of screening using the GDS-15; 378 (45%) patients completing the GDS-15 screened positive for depression, and 137 were enrolled for a 12-month prospective follow-up. Mean GDS-15 scores improved from 8.8 to 7.0 (P < 0.0001) and the 39-item Parkinson's Disease Questionnaire emotional subscore from 42.2 to 36.7 (P = 0.0007).
CONCLUSIONS
CONCLUSIONS
Depression screening in PD using a formal instrument can be achieved at much higher levels than is currently practiced, but there are barriers to implementing this in clinical practice. An individual site-specific process is necessary to optimize screening rates.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Informations de copyright
© 2024 The Author(s). Movement Disorders Clinical Practice published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.
Références
Reijnders JS, Ehrt U, Weber WE, Aarsland D, Leentjens AF. A systematic review of prevalence studies of depression in Parkinson's disease. Mov Disord 2008;23:183–189. quiz 313.
Schrag A, Jahanshahi M, Quinn N. What contributes to quality of life in patients with Parkinson's disease? J Neurol Neurosurg Psychiatry 2000;69:308–312.
Bega D, Wu SS, Pei Q, Schmidt PN, Simuni T. Recognition and treatment of depressive symptoms in Parkinson's disease: the NPF dataset. J Parkinsons Dis 2014;4:639–643.
Shulman LM, Taback RL, Rabinstein AA, Weiner WJ. Non‐recognition of depression and other non‐motor symptoms in Parkinson's disease. Parkinsonism Relat Disord 2002;8:193–197.
Okun MS, Siderowf A, Nutt JG, et al. Piloting the NPF data‐driven quality improvement initiative. Parkinsonism Relat Disord 2010;16:517–521.
Unutzer J, Park M. Strategies to improve the management of depression in primary care. Prim Care 2012;39:415–431.
Baek WS, Swenseid SS, Poon KY. Quality care assessment of Parkinson's disease at a tertiary medical center. Int J Neurosci 2013;123:221–225.
Kelvin LC, Justin M, Juliana A, et al. Quality improvement in neurology. Neurology 2021;97:239–245.
Barr PJ, Forcino RC, Dannenberg MD, et al. Healthcare options for people experiencing depression (HOPE*D): the development and pilot testing of an encounter‐based decision aid for use in primary care. BMJ Open 2019;9:e025375.
Weintraub D, Oehlberg KA, Katz IR, Stern MB. Test characteristics of the 15‐item geriatric depression scale and Hamilton depression rating scale in Parkinson disease. Am J Geriatr Psychiatry 2006;14:169–175.
Weintraub D, Saboe K, Stern MB. Effect of age on geriatric depression scale performance in Parkinson's disease. Mov Disord 2007;22:1331–1335.
Williams JR, Hirsch ES, Anderson K, et al. A comparison of nine scales to detect depression in Parkinson disease: which scale to use? Neurology 2012;78:998–1006.
Starks H, Trinidad SB. Choose your method: a comparison of phenomenology, discourse analysis, and grounded theory. Qual Health Res 2007;17:1372–1380.
Kroenke K, Spitzer RL, Williams JB. The patient health Questionnaire‐2: validity of a two‐item depression screener. Med Care 2003;41:1284–1292.
Goetz CG, Tilley BC, Shaftman SR, et al. Movement Disorder Society‐sponsored revision of the unified Parkinson's disease rating scale (MDS‐UPDRS): scale presentation and clinimetric testing results. Mov Disord 2008;23:2129–2170.
Martinez‐Martin P, Schapira AH, Stocchi F, et al. Prevalence of nonmotor symptoms in Parkinson's disease in an international setting; study using nonmotor symptoms questionnaire in 545 patients. Mov Disord 2007;22:1623–1629.
Beck AT, Ward CH, Mendelson M, Mock J, Erbaugh J. An inventory for measuring depression. Arch Gen Psychiatry 1961;4:561–571.
Benedict RH, Fishman I, McClellan MM, Bakshi R, Weinstock‐Guttman B. Validity of the Beck depression inventory‐fast screen in multiple sclerosis. Mult Scler 2003;9:393–396.
Marck CH, Hunter A, Butler E, et al. Assessment and treatment of depression in people with multiple sclerosis: a qualitative analysis of specialist clinicians' experiences. Mult Scler Relat Disord 2022;57:103362.
Gandy M, Modi AC, Wagner JL, et al. Managing depression and anxiety in people with epilepsy: a survey of epilepsy health professionals by the ILAE psychology task force. Epilepsia Open 2021;6:127–139.
Tornatore C, Ahmad A, Pham T, Gupte‐Singh K, Wahid N, Lynch J, Pratt KJ. Identification of cognitive impairment, depression, and fatigue among multiple sclerosis patients in a large comprehensive care center: a mixed‐methods, qualitative study. Mult Scler Relat Disord 2022;68:104117.
Jetté N, Amoozegar F, Patten SB. Depression in epilepsy, migraine, and multiple sclerosis: epidemiology and how to screen for it. Neurol Clin Pract 2017;7:118–127.
Lewis CC, Boyd M, Puspitasari A, et al. Implementing measurement‐based Care in Behavioral Health: a review. JAMA Psychiatry 2019;76:324–335.
Bahadoran P, Varela R, De Angelis A, Paviour D, Agrawal N. Screening for depression in movement disorders clinic. Neurol Sci 2021;42:969–978.
Micoulaud‐Franchi J‐A, Bartolomei F, McGonigal A. Ultra‐short screening instruments for major depressive episode and generalized anxiety disorder in epilepsy: the NDDIE‐2 and the GAD‐SI. J Affect Disord 2017;210:237–240.
Mohr DC, Hart SL, Julian L, Tasch ES. Screening for depression among patients with multiple sclerosis: two questions may be enough. Mult Scler 2007;13:215–219.
Munger Clary HM, Wan M, Conner K, et al. Examining brief and ultra‐brief anxiety and depression screening methods in a real‐world epilepsy clinic sample. Epilepsy Behav 2021;118:107943.
Swartz RH, Cayley ML, Lanctôt KL, et al. The "DOC" screen: feasible and valid screening for depression, obstructive sleep apnea (OSA) and cognitive impairment in stroke prevention clinics. PLoS One 2017;12:e0174451.
Thompson AGB, Sheldon R, Poole N, et al. A new way of rapidly screening for depression in multiple sclerosis using emotional thermometers. Acta Neuropsychiatr 2019;31:151–158.
Vahter L, Kreegipuu M, Talvik T, Gross‐Paju K. One question as a screening instrument for depression in people with multiple sclerosis. Clin Rehabil 2007;21:460–464.
Rüsch N, Angermeyer MC, Corrigan PW. Mental illness stigma: concepts, consequences, and initiatives to reduce stigma. Eur Psychiatry 2005;20:529–539.