News Release

Depression screening improves care for patients with cancer

A Kaiser Permanente study shows a well-designed screening program for patients with breast cancer increased assessments for depression and referrals for appropriate care.

Peer-Reviewed Publication

Kaiser Permanente

PASADENA, Calif. Kaiser Permanente research published January 4, 2022, in JAMA showed depression screening for patients with newly diagnosed breast cancer was highly effective at identifying patients in need of behavioral health care, and the new screening initiative was subsequently and successfully built into the patient care and daily workflow of medical oncology teams at Kaiser Permanente in Southern California.

“Early identification and treatment for mental health issues is critical, yet depression and other mental health issues are often underidentified and undertreated in breast cancer patients,” said the study’s lead author, Erin E. Hahn, PhD, a research scientist with Kaiser Permanente Southern California Department of Research & Evaluation. “Our study showed that the use of implementation strategies to facilitate depression screening is highly effective and provided insights into how to create a sustainable program to help our cancer patients achieve the best possible health.”

It has been difficult historically to incorporate mental distress screening during cancer care when patients tend to be vulnerable to mental health challenges. Researchers from Kaiser Permanente in Southern California set out to determine if a process of incorporating depression screening into routine clinical care with support from researchers might make a difference.

They separated medical oncology teams at different locations into 2 groups. In the first group, physicians and nurses received education about depression screening, regular feedback on their performance, and support in determining the best ways to add depression screening into their current workflow. In the second group — the control group — physicians and nurses received only education. Screening was conducted using the Patient Health Questionnaire 9-item version, known as the PHQ-9.

All patients diagnosed with new breast cancers who had a consultation with medical oncology between October 1, 2017, and September 30, 2018, were included in the study. Researchers enrolled 1,436 members: 692 in the control group and 744 in the intervention group. The groups were similar in demographic and cancer characteristics.

  • 80% of patients in the intervention group completed depression screening versus less than 1% in the control group.
  • Of intervention group screenings, 10% scored in the range indicating need for referral to mental health services. Of those, 94% received referrals.
  • Of those referred, 75% completed a visit with a mental health provider.
  • Additionally, patients in the intervention group had significantly fewer clinic visits to the oncology departments, and no difference in outpatient visits for primary care, urgent care, and emergency department services.


“The trial of this program was so successful that, with funding from our Care Improvement Research Team, we have rolled out depression screening initiatives across all our Kaiser Permanente medical oncology departments in Southern California,” said Hahn. “We are incorporating the lessons learned from the trial, particularly the importance of ongoing audit and feedback of performance, and are encouraging our clinical teams to adapt the workflow to meet their needs.”

About Kaiser Permanente

Kaiser Permanente is committed to helping shape the future of health care. We are recognized as one of America’s leading health care providers and not-for-profit health plans. Founded in 1945, Kaiser Permanente has a mission to provide high-quality, affordable health care services and to improve the health of our members and the communities we serve. We currently serve approximately 12.5 million members in 8 states and the District of Columbia. Care for members and patients is focused on their total health and guided by their personal Permanente Medical Group physicians, specialists, and team of caregivers. Our expert and caring medical teams are empowered and supported by industry-leading technology advances and tools for health promotion, disease prevention, state-of-the-art care delivery, and world-class chronic disease management. Kaiser Permanente is dedicated to care innovations clinical research, health education, and the support of community health.

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