Ideally, doctors should ask patients about their moods as part of a regular wellness visit, Dr. Borenstein said — there doesn't necessarily need to be a special visit to gauge mental health. But if the doctor doesn't bring it up, patients can educate themselves and start the conversation with their physicians.
Jeffrey Cain, president of the American Academy of Family Physicians, said family doctors were trained to spot symptoms of mental illness, like depression, and he encouraged patients to bring in questions or concerns for discussion. But people don't necessarily go to their family doctor and say they are depressed, he said. Rather, they say they're tired, or that they lack energy, that they're having trouble concentrating or that their body aches — all of which can be symptoms of depression or anxiety.
There are some well-known screening tools that patients can use as a starting point to assess themselves, to help prompt a conversation with their doctor. Dr. Borenstein mentioned a common tool used by doctors to assess patients for depression: a "P.H.Q.," for "patient health questionnaire" He cautioned that the idea here was not to self-diagnose using such forms — there are several versions, varying by number of questions — but rather to self-assess, and then discuss your concerns with a professional.
The P.H.Q.-9, which asks nine questions, was developed by researchers at Columbia University and Indiana University, with help from a grant from Pfizer Inc. The form is available on several Web sites, including (phqscreeners.com/pdfs/02_PHQ-9/English.pdf).
It asks about the patient's outlook and health habits over the previous two weeks. The first question, for instance, asks patients whether they have had "little interest or pleasure" in doing things and asks them to check a box ranging from "not at all," which scores a zero, to "nearly every day," which scores a 3. A professional computes a total score, which gives more weight to frequent symptoms; the higher the score, the greater the likelihood of significant depression.
Another set of screening tools for depression and other mental health disorders were developed by Screening for Mental Health, a Boston-area nonprofit that creates assessment tools for use by health plans, colleges, the military and the general public. Founded by Douglas Jacobs, an associate clinical professor of psychiatry at Harvard Medical School, the organization grew out of the first National Depression Screening Day, which is held annually each October during Mental Illness Awareness Week.
Mental illnesses have specific signs and symptoms, much as a disease like diabetes does, Dr. Jacobs said, and those symptoms can be identified and treated. Take depression, again, as an example. It's normal to be sad for a while after a personal loss or a traumatic event. But when the effects linger and begin to affect your self-esteem, or interfere with your ability to do your job or handle other responsibilities, he said, you may want to consider if you are suffering from a more serious depression that should be treated professionally — with behavioral therapy, medication or both.
At the site helpyourselfhelpothers.org, which is sponsored by Screening for Mental Health, you can find locations near you that offer mental health services. Or, you can use a free online screening tool that can help you gauge if you might be at risk for various illnesses including depression, anxiety, bipolar disorder, eating disorders and post-traumatic stress disorder.
You can choose a specific screening or answer questions to help narrow your choice. For instance, the tool asks you to complete the sentence "I have been..." with phrases like "feeling sad or empty," or "drinking more than planned."
The depression screening tool asks questions about how you have been feeling during the last two weeks, like whether you have been "blaming yourself for things" some of the time, all of the time, or most of the time.
The questionnaire concludes with a finding based on your answers. For instance, it might tell you that "Your screening results are consistent with symptoms of an eating disorder," along with a recommendation to seek a professional evaluation. Gina N. Duncan, an assistant professor of psychiatry at the Medical College of Georgia at Georgia Health Sciences University in Augusta, who has blogged about the notion of a personal mental health checkup, said sleep disruptions were often a sign of stress. If you're sleeping much more or less than usual, or having difficulty falling asleep, that can be a warning signal.
Many large employers include mental health coverage as part of their health benefits packages, and recent federal rules on benefits "parity" mean such benefits at large plans should not have higher have co-payments and deductibles or stricter limits on treatment than benefits for other medical or surgical needs. Also, most large companies currently offer employee assistance plans, which provide counseling and referrals — both over the phone and in person — to workers and members of their families who are suffering from personal crises.
Helen B. Darling, president of the National Business Group on Health, a consortium of large employers, said employee assistance plans were an important way to screen for mental health problems. Help through them is generally provided free of charge outside of the main health insurance plan, so using the service does not generate an insurance claim.
Over all, however, 15 percent of employers in the United States do not offer mental health coverage to employees, according to the Society for Human Resource Management. Such benefits may become more widely available in 2014, when many provisions of the Affordable Care Act take effect. Mental health benefits will be part of the "essential package" that must be offered by many insurance plans, including the new state-sponsored insurance exchanges.
