Thursday, November 10, 2005

Screening for depression-has the time come for this idea?

Seemingly so. Aetna will now begin to pay primary care doctors for screening for depression.The NYT article referred to above gives some of the particulars and some interesting background.The IOM has recently published a paper of the issue.SSRI manufacturers have to be pleased with the efforts.I read about this and have mixed feelings.Depression is clearly a bad thing and can be devastating to patients and family members.I cannot help but wonder why a big insurer initiates a program that will at least in the short run cost more money.Comments are made that it will save money in the long run but that is an expectation not a proven cost effectiveness fact.There are so many conditions for which primary care doctors could screen and we are urged to do so for many such conditions such as domestic violence, early COPD in smokers with office spirometry,lower urinary tract symptoms in men to name only a few.
In 2002 the USPSTF gave depression screening in adults a grade B recommendation ("fair" evidence). I claim no special expertise in understanding insurance company reasoning underlying decisions but the "follow the money" rule works most of the time. My guess is that large companies who are Aetna's real clients perceive that they are loosing money (decreased productivity) from employees with depression. They apparently also believe that early detection and treatment of depression will in the long run save them money. This notion is so intuitively appealing that it does not take much of an argument to convince executives. This may be true but I doubt there is much hard evidence to that effect. So I am guessing the coporate clients have pressured the insurance companies to provide this service and likely the cost gets pushed back to the corporate clients.Generally, treating depression is a good thing and maybe screening for it is a good thing as well.However, to expect that someday it will be shown that a given company's productivity increases because of this is very unlikely.The causative chain from screening to improved worker behavior and less time off is long and vulnerable to many potential pertubations.

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