it is estimated that 26.2% of americans aged 18 and older ( about 1 in 4 adults ) have a diagnosable mental disorder . in the aftermath of the sandy hook tragedy ,
mental health has been recognized as a priority issue in the united states , specifically depression . in a study by the centers for disease control and prevention , among a sample of 235 067 adults ( in 45 states , the district of columbia , puerto rico , and the us virgin islands )
, 9.1% met the criteria for current depression ( significant symptoms for at least 2 weeks before the survey ) , including 4.1% who met the criteria for major depression .
depression can be described as a state of low mood and a loss of interest in daily activities .
it can be accompanied by other symptoms such as guilt , low energy , the disturbance of appetite and sleep , and concentration .
these feelings can lead to extreme thoughts or actions , including suicide . according to the american foundation for suicide prevention , over 60% of all people who die by suicide have major depression . 
 
the us preventive services task force ( uspstf ) recommends screening adults for depression in primary care practices that have systems in place to assure accurate diagnosis , effective treatment , and follow - up . 
 
primary care settings are the locale where up to 70% of patients are diagnosed and treated for the most prevalent mental health conditions including anxiety , mood , and substance abuse disorders .
furthermore , medical comorbidity is the rule for this population in which the majority have at least 1 co - occurring chronic medical illness . because many acute and chronic medical conditions ( eg , chronic pain , copd , obesity ) involve health behaviors or psychosocial issues with the potential to exacerbate symptoms or undermine treatment outcomes , primary care is well suited as the medical home for provision of essential behavioral health care .
there is a growing amount of research , which shows that integrated behavioral care produces significant positive results , including decreases in depression levels , improvement in quality of life , decreased stress , and lower rates of psychiatric hospitalization .
analysis of national ambulatory medical care surveys from 2003 to 2006 revealed that , despite the high prevalence of depression in primary care , screening is extremely low at 2% to 4% . per the 2013 study by mcgoey
et al , the average annual frequency of documented depression screening was 1.3% . for visits to primary care providers specifically , the rate of screening was 1.8% , for internists it was 2.8% , and for pediatricians it was 1.8% . 
 
there are many standardized depression screening tools that can be used by primary care medical providers , but the study shows that an overwhelming 65% are using the patient health questionnaire 2/9 ( phq-2/9 ) screening tools .
the phq-2 inquires about the frequency of a patient s depressed mood and anhedonia ( lack of interest or pleasure in doing things ) over the past 2 weeks .
it is not used to establish a diagnosis , but it is the first step in identifying possible depressive symptoms .
a study by arroll et al in 2010 reported that a phq-2 score of 2 or higher has a sensitivity of 0.86 , meaning that 86% of those with a major depression will be found to be positive on the phq-2 screening test .
patients who test positive are further evaluated with phq-9 and diagnostic and statistical manual of mental disorder criteria to determine whether they meet the criteria for a depressive disorder . 
 
the purpose of this study is to examine the rate of depression screening among patients , aged 19 and older , seen at a community health center while referencing to uspstf screening recommendations .
the purpose of this study is to examine the rate of depression screening among patients , aged 19 and older , seen at a community health center while referencing to uspstf screening recommendations .
a random sample of 500 patients , aged 19 and older , were extracted from the total number of patients who have been seen at the community health center , between december 1 , 2013 , and april 30 , 2014 , using electronic medical records ( emrs ) . using the emr software ,
the patients who were previously diagnosed with depression were excluded from the total screened for depression .
the data was then broken down by gender , race , and ethnicity to see whether there are any significant trends that can be compared to national averages .
of the 500 patients in the sample , 49 of them were excluded due to being previously diagnosed with depression .
subsequently , data examined by gender showed the rate of screening of males was 8.4% , and for females , it was 17.5% ( table 1 ) .
depression screening data by gender . additionally , the race with the highest rate of screening was asian , with 23.2% of patients being screened , and the race screened at the lowest rate was white , at 12.8% .
then looking at the data - based ethnicity showed that a slightly higher percentage of hispanics were screened ( 15.3% ) than non - hispanics ( 14.8% ) , and those patients who did not report their ethnicity ( 8.7% ) ( tables 2 and 3 ) .
compared to available data on depression screening , for example , the study by cherry and mcgoey et al ( 1.8% and 4% respectively ) , 
  the rate of screening at the community health center was significantly better .
primary care providers then either treat depression in primary care setting or use appropriate referral pathways to address depression , since offering treatment after depression screening improves outcomes .
several studies have shown that major depression is more frequent among members of minority groups than among whites . a 2005 study by riolo
et al examined racial / ethnic differences among middle - aged women and found that depressive symptoms among hispanic and african american women were higher compared to other ethnicities .
also , a 2010 study by gonzlez et al showed that african americans and hispanics exhibited elevated rates of major depression relative to whites .
previous research has also shown that socioeconomic indicators , such as education , income , and marital status , are associated with depressive symptoms and , in some cases , may explain racial / ethnic differences in rates of depression .
there is also clear evidence that females are more likely to have depressive symptoms compared to males .
our study findings seem to mirror current differences in race , ethnicity , and gender .
community health centers aid the underserved , with a significant portion of the population belonging to the lower socioeconomic strata and minority race or ethnicities .
screening and treatment of depression in the community health centers setting deserve special focus . however , behavioral health is not currently fully integrated into general internal medicine at primary care practices , including community health centers .
current health care policy makes it difficult for most primary care practices to integrate mental health staff because of insufficient reimbursement , mental health insurance carve outs , and difficulty in supporting collocated mental health professionals , to name a few .
the particular health center , at the time of the survey , did not offer on - site behavioral health services , that is , there were no psychologists , case workers , or psychiatrists on staff .
furthermore , physicians , physician assistants , and nurse practitioners often lack the time or training to effectively address mental health needs .
primary care providers also continue to encounter barriers to referring patients to specialty mental health settings , while patient uptake to these offsite referrals remains low .
finally , patients might be reluctant to talk about mental health problems such as depression . per the study by psych central in 2011 , 43% were hesitant to talk to their primary care physician about their depressive symptoms .
the most common reason was they did nt want to be put on medications , such as antidepressants .
also , 16% of patients said they did nt think talking about emotional issues were a part of their physician s job , while others stated that they did nt want to be  branded  as being a psychiatric patient with a mental disorder . 
 
our study was designed to survey the screening rates and provide evidence of its lack .
therefore , future studies should be designed to look not only into the rates but also to determine the underlying factor for why almost 85% of patients were unfortunately not screened . in summary , although mental health wellness has drawn more public attention in recent years , there continues to be barriers surrounding mental health , including depression .
improving screening and treatment for depression in primary care will require better mental health care integration . enhanced coordinated financial support for the integration of mental health care into primary care could improve identification and treatment of depression .
there is an urgent need for quality improvement initiatives that look into the current practices and potentials for innovations and integrations .
the studied community health center had the rate of depression screening at 14.6% , while the current recommendation is universal screening of depression , per the uspstf .
since evidence shows that mental health can coexist with medical illness and integration of mental health services to primary care improves overall outcomes , there is an overarching need to improve the screening rates .
mass screening in primary care will help clinicians identify missed depression cases and initiate appropriate treatment earlier in their course of depression .
addressing barriers to screening , including patient education , provider education , system practices , and provision of screening and treatment resources could help address this important health care gap .
 purpose : the purpose of this study is to examine the rate of depression screening among patients , aged 19 and older , seen at a community health center , while referencing to us preventive services task force ( uspstf ) screening recommendations.methods:a random sample of 500 patients , aged 19 and older , were extracted from the total number of patients seen at the community health center , between december 1 , 2013 , and april 30 , 2014 . 
 the rate of depression screening was calculated by analyzing the completed standardized screening questionnaires ( patient health questionnaire 2).results : on analysis , it was found that 14.6% of patients were screened for depression . 
 the rate of screening for males was 8.4% and for females it was 17.5% . 
 the race with the highest rate of screening was asian at 23.2% , and the lowest rate was white at 12.8%.conclusion : the studied community health center had a suboptimal rate of depression screening at 14.6% . 
 the uspstf recommends depression screening on all adults . 
 addressing barriers to screening including patient education , provider education , system practices , and provision of resources may help improve the rate of depression screening , leading to early treatment and better health outcomes . 
Introduction
Purpose
Method
Results
Discussion
Conclusion