Call for QOF to cover depression screening in all chronic diseases

UK researchers say all patients with chronic respiratory illness should be screened for depression, in addition to CHD and diabetes patients currently targeted in the QOF.

The researchers compared 2004/5 disease prevalence data from 8,576 practices in England with national data on antidepressant prescribing.

A high COPD prevalence was the single strongest predictor of a high antidepressant prescribing rate. Epilepsy, CHD and asthma prevalence were also strongly linked to antidepressant prescribing.

Other predictors included social deprivation and ethnicity.

Lead researcher Dr Paul Walters, from the Institute of Psychiatry in London said: 'Although we couldn't measure actual rates of depression in these illnesses, this study provides evidence that depression screening should be considered in patients with COPD and asthma.'

Welsh Practice Nurse Association chair Eileen Munson backed the call to extend depression screening.

'It's not surprising that depression is more prevalent in COPD patients. The impact on breathing means it limits all activities in daily living. I would support changing the QOF to screen for depression in more chronic disease patients,' she said.

Although diabetes was often a severely limiting condition with high rates of mortality, she pointed out that it could often be more easily managed than COPD.

Dr Tim Saunders, GP and mental health lead for Chester West PCT backed screening for depression in all patients with chronic diseases.

'These patients could be routinely screened for depression when they come in for their patient review, as those with diabetes and CHD currently are,' he said.

Dr Richard Vautrey, deputy chair of a the BMA's GP committee, agreed that QOF points for depression screening in patients with CHD and diabetes could be extended to cover COPD and asthma.

'When this indicator is reviewed, if there is evidence that depression is linked to COPD and other respiratory diseases then they could be included,' he said.

- B J Psych 2008; 193: 235-9

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