Background/Purpose: Depression in patients with arthritis is common and leads to poor health outcomes. While it has been shown that rheumatologists rarely communicate about depression to their patients with arthritis, there are no data about screening practices for depression in this population. Our objectives were to describe national rates of depression screening in patients with arthritis and real-world practices for mental health referrals for patients with arthritis and prevalent depression.

Methods: In 2005 the National Ambulatory Medical Care Survey, an annual visit-based cross-sectional survey conducted in physicians’ offices, began collecting data about depression screening practices. Using 2005-2009 data, we compared office visits coded for current arthritis with other office visits to assess the rate of pre-existing depression, depression screening, and mental health referrals. Of 102,050 adult visits, we identified 14,611 coded for current arthritis (osteoarthritis and/or inflammatory arthritis) over the five-year study period. Multivariate logistic regression adjusted for age, race, and gender determined the independent association of depression and arthritis. Patients with a current diagnosis of depression were excluded from analyses of depression screening practices leaving 12,457 patient visits without depression. The chi-square test of association was used to compare depression screening practices, provider characteristics, and referral rates for mental health services between patients with and without arthritis. Patients with and without arthritis who had a current diagnosis of depression (n=11,664) were included in analyses for mental health referrals.

Results: The odds ratio for comorbid depression in patients with arthritis was 1.5 (95% CI 1.4, 1.6) controlling for age, race, and gender. Depression screening occurred in 77 (0.6%) of the eligible 12,457 visits associated with arthritis. Patients with arthritis were less likely to have depression screening services at their office visit compared to patients without arthritis (OR .69; 95% CI .54, .87). No rheumatologists screened their patients with arthritis for depression. Patients with arthritis and depression were less likely to receive referrals for psychotherapy (OR .43; 95% CI .38, .51), mental health providers (OR .25; 95% CI .15, .42), or other mental health services (OR .41; 95% CI .33, .51) compared to patients without arthritis.

Conclusion: Ambulatory physicians in the United States, whether they are rheumatologists or primary care providers, rarely screen for depression in patients with arthritis. Furthermore, identified depressed patients with arthritis are less likely to receive referrals for mental health services. Both recognition and treatment practices need to be improved for patients with arthritis and depression in order to improve health outcomes.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/meager-depression-screening-and-mental-health-referral-rates-for-patients-with-arthritis-in-a-national-sample/