Depression Screening Rates and Patterns of Management in Primary Care in Qatar: A Cross-Sectional Study

Abstract

Background: Depression is one of the main public health problems and a leading cause of disability. It was estimated in 2019 that depression affects more than 279 million people worldwide. According to World Health Organization survey in 2017, the estimated global prevalence of depression was 5.1%. Depression screening is considered the cornerstone of managing people with depression in primary care. However, the screening rates remain low worldwide. Up-to-date information on depression screening rates and management patterns in the Primary Health Care Corporation (PHCC) in Qatar is lacking. Aim: To estimate and compare the annual screening rates for depression and describe management of adults screened for depression in PHCC centers in Qatar in 2017 and 2019. Methods: This is a cross-sectional study design based on secondary data of individuals aged 18-65 years in the PHCC with a completed Patient Health Questionnaire (PHQ-9) in 2017 and 2019. The number of individuals screened for depression among individuals who consulted a PHCC physician at least once was used to determine the annual depression screening rate. Antidepressants prescribed in the PHCC among individuals screened for depression were used to determine the annual proportion of individuals prescribed antidepressants. Similarly, referral of individuals to different psychiatric clinics in the PHCC and secondary care among individuals screened for depression was used to determine the annual proportion of referrals to PHCC support clinic, PHCC psychiatry clinic, and secondary care psychiatry clinic. Ordinal regression analysis was used to assess the association between participant characteristics, year of screening, and depression symptoms severity. Similarly, multiple logistic regression was used to assess the association between participant characteristics, year of screening, and receiving antidepressant prescription and referral to psychiatry clinics. Results: A total of 5,467 patients were screened for depression in 2017 and 2019. The Mean age and standard deviation of patients were 42.8±12.4 years and 37.8 ±11.4 years in 2017 and 2019, respectively. Of the total patients, 63.4% were female; other nationalities were 73.7% of the total screened patients. Depression screening rates were 6 per 1000 people in 2017 and in 2019. The proportion of persons prescribed antidepressants increased between 2017 and 2019 from 19.4% to 28.2%. The overall referral to any psychiatric clinic increased from 2.5% in 2017 to 8.0% in 2019. Younger age, female, gender, and those screened in 2019 had higher severity of depression symptoms. Older age and those screened in 2019 were more likely to receive antidepressant prescriptions. Older age, female gender, Qatari nationality, and those who were screened in 2019 were more likely to be referred to support and psychiatry clinics. Conclusion: Depression screening rates in the PHCC are still considered low despite the integration of mental health services into the PHCC centers, despite noticeable increase in referrals to different mental health clinics as well as antidepressants prescribing between 2017 and 2019. Females and younger age groups were more likely to present with more severe symptoms. However, males and younger individuals were less likely to be referred to mental health clinics and prescribed antidepressants. In addition, Qatari individuals were more likely to be referred to mental health clinics compared to individuals from other nationalities. More research and quality improvement work are needed to further investigate the screening and management patterns for depression focusing on age, gender, nationality and contextual factors which may hinder access or health seeking behavior for mental healthcare services in the PHCC.