Almost half of adults who committed suicide had contact with a primary care provider in the month before their death.* Depression is a risk factor for suicide, the tenth leading cause of death in the United States, and it is estimated that only 66 percent of adults with depression receive treatment.†,‡
Regular patient screening supports the identification and diagnosis of depression, ensuring appropriate treatment and follow-up care. However, some patients may not admit to or mention concerns about depressed mood, cognition changes, or physical symptoms. It is important to consistently assess patient risk factors and presenting symptoms.
Depression risk factors and symptoms
People with co-occurring serious chronic medical illnesses and depression tend to have more severe symptoms of both illnesses, requiring additional treatment and care, and incurring added medical costs.§ Depression may follow childbirth and is associated with adverse maternal and infant outcomes. It is estimated that 13 percent of women in the U.S. will experience postpartum depression; some states report this rate may be as high as 24 percent.¶
Patients experiencing depression may have chief complaints of non-specific symptoms such as:
- changes in appetite
- lack of energy
- sleep disturbances
- general aches and pains
- menstrual symptoms
- digestive problems or abdominal pain
- sexual dysfunction*
When patients present with non-specific symptoms, it may be important to consider depression as a differential diagnosis and to further discuss the presence of other symptoms (e.g., changes to weight or appetite, insomnia or hypersomnia, fatigue, feelings of worthlessness or guilt, acute suicidality, etc.).
Screening tools and other resources
Risk reduction strategies include regular use of a depression screening tool for your general adult population, including pregnant and postpartum patients. Magellan Healthcare, Inc. (Magellan) provides a Behavioral Health Toolkit for Medical Providers for more information about identifying and treating depression, including access to screening tools, clinical guidelines, and patient resources.
Referral to a behavioral health provider is recommended for complex cases, including patients with bipolar depression, acute suicidality, psychosis, or pregnancy. If you refer your patient to a behavioral health provider, regular communication and coordination will help ensure an accurate diagnosis, effective treatment, and appropriate follow-up care.
For most of your Independence patients, Magellan administers behavioral health benefits. Call the number on the back of the member's benefits card to arrange a referral. You may also use
Quartet Health's secure and virtual platform to screen and refer patients for behavioral health care that matches their clinical needs, personal preferences, and insurance coverage. Members may also be referred to Quartet by an Independence case manager or may sign up for care through the platform on their own.
Other useful resources include:
Suicide Prevention Resource Center: This service provides information on strategic suicide prevention planning, resources and programs, and trainings for professionals.
Zero Suicide: This framework provides functional tools and resources for system-wide transformation toward safer suicide care in health and behavioral health systems.
Independence Know Your Mind: This webpage provides information for our members to learn about depression and anxiety, including information about self-care, building resilience, and talking to a health care provider.
Be sure to discuss appropriate resources with your patients. Please encourage the member to call the number on the back of their ID card if they need mental health services.
*Ferenchick, E. K., Ramanuj, P., & Pincus, H. A. “Depression in primary care: part 1–screening and diagnosis." British Medical Journal; 365, l794. 2019. Available from: https://www.bmj.com/content/bmj/365/bmj.l794.full.pdf
†Centers for Disease Control and Prevention, National Center for Health Statistics. “Health, United States, 2019." Hyattsville, MD. 2021. Available from: https://www.cdc.gov/nchs/data/hus/hus19-508.pdf
‡SAMHSA. “Key substance use and mental health indicators in the United States: Results from the 2019 National Survey on Drug Use and Health." HHS Publication No. PEP20-07-01-001, NSDUH Series H-55. 2020. Available from: https://www.samhsa.gov/data/report/2019-nsduh-annual-national-report
§National Institute of Mental Health. "Chronic Illness & Mental Health." NIH Publication No. 15-MH-8015. Available from: https://www.nimh.nih.gov/health/publications/chronic-illness-mental-health/index.shtml
¶Bauman, B. L., et al. “Vital Signs: Postpartum Depressive Symptoms and Provider Discussions About Perinatal Depression – United States, 2018." Morbidity and Mortality Weekly Report; 69, 19. 2020. Available from:
Magellan Healthcare, Inc., an independent company, manages mental health and substance abuse benefits for most Independence members.