Depression, Anxiety Rarely Assessed in Patients with Otolaryngologic Disorders

A variety of tools are available to help healthcare providers screen patients for depression, anxiety, and other mental health issues. Screening your patients, on admission and periodically during treatment, can help you determine which patients are doing fine and which may benefit from additional intervention.

A formalized screening process is necessary because it’s impossible to screen patients just by looking at their history, said Christine Gourin, MD, MPH, associate professor of otolaryngology at Johns Hopkins University in Baltimore. “Not everybody with depression will have it recorded in their medical record, and many patients don’t talk about it either.” Talking to patients and observing their mood and affect can be helpful but should not replace the use of a validated screening tool.

The next step is to “figure out what to do when someone screens positive,” said Stacey Ishman, MD, MPH, surgical director for the Upper Airway Center at Cincinnati Children’s Hospital Medical Center. “That may be something as simple as sending them to the ER to be taken care of urgently if someone is really having difficulty or experiencing suicidal ideation. People who score above the positive threshold but are not urgent may need to see a social worker or receive a referral to a mental health provider.”

Establishing an algorithm and relationships with mental health professionals will help you effectively manage patients’ mental health needs without taking too much time away from otolaryngologic treatment. “Having relationships with mental health providers, programs, and hospitals that can serve patients’ needs is so important,” said Lawrence Miller, PsyD, director of integration and wellness for Rogers Partners in Behavioral Health, LLC, in Milwaukee, Wis. “Getting a person from referral to treatment can be a challenge.” Pre-established relationships and easy availability of mental health increase the probability of patients receiving necessary mental health assessment and treatment. “Research has shown that on average, 40% to 50% of patients will follow through on a referral to a health provider,” Dr. Miller said. “If the provider is on site, that can increase to 80% or 90%.”

Maximizing otolaryngologic treatment may help ease patients’ distress. Both continuous positive airway pressure and surgical intervention have been shown to reverse some depression in patients with sleep apnea, Dr. Ishman said. Appropriate treatment of sinus disease can also ease depression and anxiety; the same holds true for allergies.

“I tell my patients that we have to first take care of the underlying inflammatory disease process. If that takes care of the mental health problem, it’s a win-win situation,” Dr. Alt said. “If not, at least we can check that box off and move toward further treatment.”