Despite federal recommendations for depression screening, a new national study found that less than 5% of adults were screened for depression in primary care settings. The low screening rate suggests missed opportunities to identify individuals with depression and link them to care, according to study authors. The research was published online today in Psychiatric Services in Advance.

An estimated 13% to 16% of adults will experience symptoms of depression in their lifetime, and an estimated 4% to 8% experience major depression in a given year. Yet in primary care settings, depression goes unrecognized about half the time. Diagnosis and treatment rates are particularly low among certain groups, including older adults, males and African Americans. Depression screening has been recommended since 2002 and it is generally covered by private insurance and Medicare.

Researchers Ayse Akincigil, PhD, and Elizabeth B. Matthews, MSW, from Rutgers University, used the National Ambulatory Medical Care Survey to look at rates of depression screening in a sample of more 33,000 patient–physician encounters in primary care settings in 2012 and 2013. Overall, 4.2% of adults were screened for depression. Among the visits where screening took place, 47% resulted in a new depression diagnosis. This suggests that screening was heavily influenced by whether depression was suspected, the authors note.

Screening rates varied among population groups. Women were more likely to be screened than men. Patients with chronic conditions were more likely to be screened. Older adults were half as likely to be screened as middle–age adults. African Americans were half as likely as whites to be screened. The study authors note that African Americans and older adults often exhibit physical symptoms, such as headaches or body pain, rather than mood–related symptoms, making it more difficult to recognized depression. They conclude that a “failure to consistently apply standards of universal screening across all patient groups may exacerbate existing disparities in the identification and diagnosis of depression.”

Patients in practices that had fully implemented electronic health records (EHRs) were more likely to be screened than those in practices with no use of EHRs.