Effects of the 2009 USPSTF Depression Screening Recommendation on Diagnosing and Treating Mental Health Conditions in Older Adults: A Difference-in-Differences Analysis

BACKGROUND: Depression is a common mental condition in U.S. older adults. To improve rates of underdiagnosis and undertreatment for depression and other mental health conditions in primary care settings, the U.S. Preventive Services Task Force (USPSTF) updates and disseminates its depression screening guideline regularly. OBJECTIVE: To examine the effects of the 2009 USPSTF depression screening recommendation on the 3 following outcomes: diagnoses of mental health conditions, antidepressant prescriptions (overall and potentially inappropriate), and provision of nonpharmacological psychiatric services in office-based outpatient primary care visits made by adults aged 65 or older. METHODS: Data from the 2006-2012 National Ambulatory Medical Care Survey (NAMCS), a nationally representative sample of office-based outpatient primary care visits among older adults (n = 15,596 unweighted), were used. NAMCS represents physician practicing patterns of ambulatory medical care services utilization at the national level. Using a series of multivariate difference-in-differences analyses, we estimated effects of the USPSTF depression screening recommendation on the previously mentioned outcomes by comparing pre- (2006-2009) and post- (2010-2012) periods to describe primary care physician practice patterns. RESULTS: Differences in any mental health diagnosis by the depression screening status were -34.7% in the pre-2009 period and -20.2% in the post-2009 period, resulting in a differential effect of -14.4% (95% CI = -28.2, -0.6; P = 0.040). No differential effect was found in other outcomes. CONCLUSIONS: While there are mixed findings about efficacy and effectiveness of depression screening in the existing literature, more population-based observational research is needed to strengthen and support current USPSTF depression screening recommendation statements in the United States.