Table 4 Description of interventions and results of studies with combination of interventions (education, screening, and feedback)

Albedaiwi et al. (2005) [67]

Three-part intervention (raising physicians’ awareness of depression, mass depression screening using a 2-item version of the Prime-MD Questionnaire, and communicating the results of the screening to the physician)

Five months, 3 months

Identifying patients already receiving antidepressant treatment and identifying those started on treatment for depression at the time of the screening visit

A total of 10.9% pre-intervention and 16.3% post-intervention. This approach (the intervention) can greatly enhance the recognition of depression in primary care patients

Diez-Canseco et al. (2018) [68]

The intervention combined three strategies: training of PHC providers, task shifting the detection and referral of mental disorders, and a mobile health (mHealth) component comprising a screening app followed by motivational and reminder short message service to identify at-risk patients

Nine weeks

Follow-up interviews with patients and midterm and post-intervention interviews with PHCPs

Out of the 733 patients screened, 159 of them (21.7%) had a positive result by the SRQ. Of those 159, 150 (94.3%) screened positive for one disorder and 9 (5.7%) for two disorders. The average score at pretest was 12.1 (SD = 2.3) and 16.5 (SD = 1.35) at posttest

Linn et al. (1980) [69]

Group 1 completed the Zung Self-Rating Depression Scale (SDS). The scale was scored, photocopied, and attached to the patient’s chart with a note. The physician was given a picture of a 10-rung ladder to rate how his patient was feeling. Group 2 patients were asked to complete the SDS, but results were not given to the physician until after the encounter was completed. The physician first asked to rate the patient’s level of depression by use of the ladder, and then, the doctor was given feedback from the SDS screening. Group 3 patients completed the SDS, and the results were given to the physician before the encounter, but the physician’s opinion about the patient’s level of depression was not requested. Group 4 patients were asked to complete the SDS, but results were not given to the physician until after the encounter was terminated. The physician’s opinion about the patient’s level of depression was not requested. Group 5 patients were not screened for depression; however, the physicians were asked to evaluate the patient’s level of depression. Group 6 patients were not screened for depression, and the physicians were not asked to evaluate depression

Single visit, 2 weeks

Review of medical records for notations regarding depression and its treatment

When groups 1 through 4 are combined (patients receiving screening and physicians receiving feedback) and compared with groups 5 and 6 combined (no screening or feedback), notation of depression was three times more likely (25% versus 8%, P < 0.01). When groups 1 and 2 are considered together and compared with all others, the combination of screening, feedback and sensitization resulted in significantly more frequent notations of depression (32%) than any single intervention or none (13%, P < 0.01). No significant differences in notation were found when all sensitization groups (1, 2, and 5) were compared with none-sensitized groups (3, 4, and 6) (24% versus 14%)

Romera et al. (2013) [70]

PCPs in the intervention arm received a 1-day face-to-face training by a psychiatrist and four PCPs on the recommendations on screening for depression in adults, according to USPSTF 2002 guidelines, and were asked to implement them in their routine clinical practice for at least 6 months. Monthly reminders were sent by e-mail. They were also required to complete a form each month indicating adherence and acceptance and feasibility

Six months, 6 months

Systematic review of the patients’ medical records carried out by the participating physicians, Hospital Anxiety and Depression Scale, and the Mini-International Neuropsychiatric Interview

Under-recognition rates were 33.9% in the intervention and 41.4% in the control. Recognition rates were 58.0% in the intervention and 48.1% in the control: OR [95% CI] 1.40 [0.73–2.68], P = 0.309)

Sorkin et al. (2019) [71]

Multicomponent mental health-IT intervention: (I) medical providers completed an online tutorial on how to provide culturally competent, trauma-informed mental health care, (ii) screening all patients just before their appointment with their physician using 2 culturally adapted instruments for depression and PTSD and providers received a printed notification results, and (iii) giving medical provider access to evidence-based clinical algorithms and guidelines through a web-based mobile application

The web-based tutorial is -h training, and duration of other components is not clear, 12 weeks

Depression was assessed using the 15-item depression subscale of the Hopkins Symptom Checklist

Approximately 81% was diagnosed with depression by their providers in the treatment group, whereas only 33% was diagnosed by their providers in the control group. Providers in the intervention were more likely to diagnose depression [odds ratio (OR), 6.5; 95% confidence interval (CI), 1.48–28.79; P = 0.013]

Whooley et al. (2000) [72]

PCPs in both intervention and control clinics were provided an educational session to improve their management skills of depression. PCPs in the intervention clinics were notified of each participant’s GDS score and given an instruction sheet indicating the ranges of scores associated with depression

One-hour educational session for physicians and for patients weekly educational sessions, 2 years

Blinded review of all outpatient physician diagnosis forms, telephone interview, and GDS

Fourteen percent of participants (331/2346) had GDS scores suggestive of depression (GDS ≥ 6) at baseline. During the 2-year follow-up period, 56 (35%) of the intervention participants and 58 (34%) of the control participants received a physician diagnosis of depression

Williams et al. (1999) [73]

Physicians were given a copy of the Quick Reference Guide for Clinicians on managing depression in primary care and a continuing medical education session on interpreting case-finding questionnaires and diagnosing and treating depression. Patients assigned to case finding completed the depression questionnaire, and the results were reported to their physician on a bright orange report form. Questionnaire results were reported as negative or positive

Three months

Recognition rates of depression were assessed from medical records using chart audits and compared against DSM-III diagnosis

The intervention modestly increased depression recognition (30/77 or 39%) compared with 11/38 or 29% in usual care); difference = 10%, P = 0.31) but did not affect treatment (45% vs. 43%, P = 0.88)

Yonkers et al. (2009) [74]

The program included provider education, community awareness, and direct systematic depression screening. Educational and training seminars were run for healthcare clinicians and NHHS care coordinators. Women enrolling in NHHS were administered a standardized risk assessment that included questions regarding general medical and obstetrical problems, PRIME-MD, and Brief Patient Health Questionnaire

Three years, 10 months

Detection was determined with women’s self-report and chart review

Rates of detection by the obstetrical provider differed significantly between the three groups (15%, 6%, and 5% for groups 1, 2, and 3, respectively) (P = 0.003)

Yawn et al. (2012) [75]

A practice-wide intervention consisting of postpartum depression screening, evaluation, and management based in family medicine offices. Intervention staff members received training for a multistep postpartum depression screening and diagnosis process using the EPDS and PHQ-9. They also received training and practice of nursing telephone calls and on scoring and using PHQ-9. The intervention sites had routine access to the woman’s EPDS and PHQ-9 screening score(s)

Half-day training (2 sessions 1 h each) and refresher session 6 weeks later. Control sites were given a 1-h program, 12 months

EPDS, PHQ-9, and the Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders

Three-hundred thirty-nine (29.5%) of the intervention women and 255 (25.8%) of the usual-care women reported depression symptoms. Diagnosis for postpartum depression was significantly more likely among the intervention women. That is, among those with elevated screening scores, 78/399 (41%) of usual care and 194/255 (66%) intervention receive a diagnosis (P = 0.0001)