What is Depression?
Depression, also known as major depression, major depressive disorder, or clinical depression, is a common mood disorder. It affects people of all ages, races, ethnicities, and genders and causes symptoms that impact how a person feels, thinks, and handles day-to-day activities like eating, sleeping, and working.
Depression is a risk factor for developing chronic illnesses — like diabetes and heart disease — and adversely affects the course, complications, and management of chronic diseases. Fortunately, depression is among the most treatable mood disorders. With a combination of therapy and antidepressants, individuals can manage their depression. Research has shown appropriate and reliable follow-up is highly correlated with symptom improvement.
Symptoms of depression can vary from person to person and can include:
- Feeling sad or having a depressed mood
- Loss of interest or pleasure in activities once enjoyed
- Changes in appetite
- Trouble sleeping or sleeping too much
- Loss of energy and/or increased fatigue
- Increase in purposeless physical activity, or slowed mvements/speech
- Feelings of worthlessness or guilt
- Difficulty thinking, concentrating, or making decisions
- Thoughts of death or suicide
- Irritability
Prevention, screening, assessment, and treatment of mental health conditions are public health priorities, and key objectives of Healthy People 2030. The U.S. Preventive Services Task Force (USPSTFR) supports prevention and screening through evidence-based recommendations for depression screening in children, adolescents, and adults. CMS quality program measures, Depression Screening and Follow-up Plan and Depression Remission at 12 Months, align clinical guideline recommendations and the Healthy People 2023 recommendations for routine mental health screening as part of primary care for children and adults.
Depression Screening and Follow-up Plan & Depression Remission at 12 Months
Quality programs include measures related to both depression screening (prevention) and depression remission (management).
| Description | Exclusions | |
| Depression Screening and Follow-up Plan (PREV-12) | Percentage of patients aged 12 years and older screened for depression on the date of the encounter or up to 14 days prior to the date of the encounter using an age-appropriate standardized depression screening tool AND if positive, a follow-up plan is documented on the date of the eligible encounter | – Patients in hospice – Patients with diagnosis of depression or bipolar disorder |
| Depression Remission at 12 Months (MH-1) | The percentage of adolescent patients 12 to 17 years of age and adult patients 18 years of age or older with major depression or dysthymia who reached remission 12 months (+/- 60 days) after an index event. | – Patients who died – Patients who received hospice or palliative care services – Patients who were permanent nursing home residents – Patients with diagnosis of bipolar disorder, personality disorder, schizophrenia, psychotic disorder, or pervasive development disorder |
Tips & Best Practices to Close Care Gaps in Quality Measure Programs
Depression Screening & Follow-up Plan (PREV-12)
- Screen patients aged 12 years and older using an age-appropriate standardized depression screening tool
- If multiple screenings completed, use the most recent for quality reporting
- In the medical record, document the name of the standardized tool and results from the screening, or a clinician’s interpretation of positive or negative for depression
- Ensure the provider reviews and addresses the screening on the date of the encounter
- If screening is positive, provide a follow-up plan during the encounter and document one or more of the following:
- A referral to a provide for an additional evaluation and assessment to formulate a follow-up plan
- Pharmacological interventions
- Other interventions or follow-ups for the diagnosis and/or treatment of depression
- Document patient or medical reasons for not screening:
- Patient refusal
- Cognitive, functional, or motivational limitations that may impact accuracy of results
- Urgent or emergent situations where delayed treatment would jeopardize patient’s health
- Code depression diagnoses accurately and support findings in the medical record documentation
Depression Remission at 12 Months (MH-1)
- Based on patient age, use Patient Health Questionnaire (PHQ-9) or Patient Health Questionnaire-9 Modified for Teens and Adolescents (PHQ-9M) to monitor treatment outcomes and depression severity, and to modify treatment plans
- For those with a score > 9, determine if remission is achieved 10-14 months after the date on which the first instance of the elevated score occurred, as demonstrated by a score of < 5
- If more than one PHQ-9 was completed during the 10-14 months, use the most recent score
- Combine the tool with an evaluation of side effects and use treatment algorithms to accomplish goals (achieving remission, reducing relapse or recurrence, or returning to previous function)
- Establish and maintain active support and follow-up with patients during acute and continuation phases
- Use proactive follow-up from care team members to educate and monitor the patient
- Coordinate communication and care between PCP and mental health clinician, if applicable
- Include treatment considerations like education, supportive management and monitoring, family/school involvement, case management, medication, other evidence-based treatments, or mental health provider services
- Document patient or medical reasons for not screening:
- Patient refusal
- Cognitive, functional, or motivational limitations that may impact accuracy of results
- Urgent or emergent situations where delayed treatment would jeopardize patient’s health
- Code diagnoses accurately and support findings in the medical record documentation
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