By Amanda Mauri, MPH Candidate at the University of Pennsylvania
On Tuesday the United States Preventative Service Task Force (USPSTF) recommended that all adults should be screened for depression.
This announcement is an update to the 2009 recommendation which only called for screening when “staff-assisted depression care supports” were available. The 2016 guidelines also specifically mentions pregnant women and new moms, a completely new addition.
The USPSTF is an independent panel of experts in primary care and prevention that reviews evidence and recommends clinical preventative services.
The recommendation released Tuesday hopes to increase depression screening use for the 14 percent to 23 percent of women who experience depression during pregnancy and the approximately 1 and 7 women who suffer from postpartum depression. In the announcement, the USPSTF sites evidence showing that screenings are linked to increased treatment access and reduced depressive symptoms.
USPSTF influences screening use because insurers must cover services based on their recommendations. Following the Patient Protection and Affordable Care Act (ACA), insurers are now required to cover any service rated A or B - services supported by the largest body of evidence according to the USPSTF rating scale - without any cost to the patient.
Supported by several studies (Solanki 1999, Solanki 2000, Trivedi 2008, Wright 2005, Slade 2005), lawmakers believed that by eliminating cost-sharing, patients would be more likely to consume preventative services and providers would be more likely to administer screenings.
Research shows that this policy change has impacted the use of physical screening services. In January 2015, a study published in Health Affairs found that ACA policy changes on services rated A or B by the USPSTF increased preventive service use for Medicare fee-for-service beneficiaries. The study included the following physical health services – abdominal aortic aneurysm screening, colorectal cancer screening, bone densitometry and mammography screening - and advanced directives.
Another study published in July 2015 in Preventative Medicine that used the Medical Expenditure Panel Survey Household Component, a nationally representative sample of US households, reported increased use of USPSTF rated A or B preventative services as well. Similar to the previous study, these researchers also only looked at physical preventative health services - blood pressure; cholesterol; flu vaccination; and cervical, breast and colorectal cancer screenings.
While these studies are necessary in evaluating the ACA policy change, they continue the longstanding practice of rarely incorporating mental health into research.
Limited data access partly explains this traditional research gap. In the study released in July 2015, the researchers were not able to evaluate changes in depression screening use “because these data were not available in the Medical Expenditure Panel Survey in all study years.” The Agency for Healthcare Research and Quality, Kaiser Family Foundation and the Health and Retirement Study similarly does not collect or analyze data on mental health preventive service use.
Funding for mental health research also contributes to this gap. Congressional appropriations to the National Institutes of Health (NIH), while not representative of all mental health research, provides an example of the difference in funding between mental health and physical health. In 2014, the three institutes focused on mental health - the National Institute of Mental Health, the National Institute on Alcohol Abuse and Alcoholism, and the National Institute on Drug Abuse - received only 2.9 million out of the 30.1 million dollar NIH budget.
Tuesday’s updated recommendation is a critical step in acknowledging the need for depression screening in all adults. However, researchers must begin to study how USPSTF recommendations impact depression screening use. Without this research, we will continue traditional inequalities and limit our ability to make evidence-based policy decisions.