1. 2015

2.  25% of patients have a mental disorder  88% of patients with mental disorder seek primary care first  60% of individuals with depression go undetected in primary care

3.  Insufficient time  Presentation with somatic symptoms  Competing problems  Stigmatization  Minimization

4. Kroenke K, Mangelsdorff AD. Am J Med. 1989;86:262-266. 3-Year Incidence (%) DizzinessChest Pain FatigueHead- ache Edema Back Pain Dyspnea InsomniaAbdom- inal Pain Numb- ness

5. The PHQ 2:

6. The PHQ 9:

7. 3 or more complaints is strongly associated with depression

8.  Groups of 2 (Patient-Physician)  Physician: I know you’re here to talk about______. Is there something else?  Patient provides somatic complaint  Physician elicits two more times  Patient provides 2more concerns  Physician pivots to empathy and asks about mood.

10.  70% of suicide victims visit a physician within 2 months preceding their death Spitzer et al. JAMA. 1994;272:1749-1756. “Over the last 2 weeks, how often have you been bothered by thoughts that you would be better off dead, or of hurting yourself in some way?” If the answer is yes: “Tell me about it.”

11. Medication Therapy Behavioral activation Increased severity indicates multimodal treatment Monitoring treatment progress