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Not just skin deep: Am I doing enough to screen for depression and suicidality in my patients?
Steve Daveluy MD, FAAD
Asking patients about depression and suicide isn’t the first thing you’d think about when describing the practice of derma- tology. However, mental health is an issue that spans nearly all specialties. Even as a specialist, my concern is my patients’ over- all health and wellness. In fact, the majority of patients with skin complaints are actually in my office because their skin disease is impacting their life socially and emotionally, as well as physically. And, we now have ample evidence demonstrating the connection between skin disease and mental health. Rates of mood disorders are rising across our population, driven by numerous threats, including the stresses of the pandemic, a divisive political environment, and the negative impact of social media and misinformation. I’m now asking myself, “Am I doing enough to screen for depression in my patients?”
I specialize in hidradenitis suppurativa (HS), a horrible disease of boils, abscesses, scarring, and tunnel formation that causes pain, disfigurement, and a profound impact on quality of life*. Recently, screening guidelines for comorbidities associated with HS were published, including a recommenda-
8 Detroit Medical News
tion to use the PHQ-9 tool to screen patients for depression, since the odds of depression are 1.3-4.8 times that of health controls. The risk of suicide in HS patients is 2.8 times healthy controls. So, I have no reason not to follow the guidelines and screen my patients, except for the fact that incorporating it into our workflow is one more task on my to-do list. HS is only one skin disease with comorbid depression, including other ailments I see every day in clinic, such as psoriasis, melanoma, eczema, and others.
Incorporating depression screening into our workflow is a challenge, but all innovation requires overcoming barriers. We are taking advantage of one of the other sources of frequent stress, our electronic health record (EHR), to actually improve patient care and facilitate screening without creating addition- al work. Our EHR has the ability to electronically distribute screening tools to our patients prior to, or at the time of, their visit. We are currently creating the tools to utilize this process to perform depression screening for our patients. We haven’t achieved our goal just yet, and I completely understand that it
Third Quarter 2022