The treatment of depression largely falls to providers in primary care settings, which have been identified as the de facto mental health delivery system (1). Systemwide programs to improve depression care have been initiated in the Department of Veterans Affairs (VA) and in other health care organizations (2,3). One such VA initiative is screening for depression as part of the Prevention Index, which was mandated in 1998 as an annual screening tool for all primary care patients. Our study investigated diagnosis patterns of depressive disorders in VA primary care clinics over a five-year period. Specifically, we wanted to determine whether primary care service use data indicated that implementing and monitoring the mandated depression screening affected depression diagnosis rates.

Data on all primary care visits were gathered from the VA's national outpatient service use database for fiscal years 1997 to 2001. In the database, all primary care visits carry a primary diagnosis that indicates the main reason for and the presenting problem at the visit as well as up to ten secondary diagnoses.

Overall, the frequency with which depression was diagnosed, as well as the percentage of the primary care population who received a diagnosis of depression, increased across the study years. As can be seen in F1, the rates of primary diagnosis of depression remained unchanged in our study.

Despite the overall increase in the diagnosis of depression in the primary care setting, it is important to note that among veterans with a primary care diagnosis of depression, the average number of primary care visits for which a primary diagnosis of depression was noted did not vary across the study period (1.4 or 1.3 visits) and falls well below guideline recommendations for the treatment of depression in this population (4).

This work was supported by grant NMH98-001 from the Department of Veterans Affairs Mental Health Quality Enhancement Research Initiative and by grant IIR-98086-3 from the Department of Veterans Affairs Health Services Research and Development Service.

Dr. Kirchner and Dr. Curran are affiliated with the Department of Veterans Affairs South Central Mental Illness Research, Education, and Clinical Center, 2200 Fort Roots Drive, Building 58, North Little Rock, Arkansas 72114 (e-mail, kirchnerjoanne@uams.edu). All of the authors are with the Department of Veterans Affairs Mental Health Quality Enhancement Research Initiative. Harold Alan Pincus, M.D., and Terri L. Tanielian, M.A., are editors of this column.