---
title: Mental Health Screening in Primary Care
description: A clinical reference on the assessment and management of common mental health conditions in the primary care setting.
keywords: [mental health, screening, depression, anxiety, primary care]
category: clinical
---

## Overview

Mental health conditions, including depression and anxiety disorders, are highly prevalent in the primary care setting. Early identification and appropriate management of these conditions is essential, as they can significantly impact a patient's overall health, quality of life, and functional status. This clinical reference provides guidance on the screening, diagnosis, and initial management of common mental health disorders in the primary care practice.

## Screening for Depression

The United States Preventive Services Task Force (USPSTF) recommends screening for depression in the general adult population, including pregnant and postpartum women. The Patient Health Questionnaire-9 (PHQ-9) is a widely used and validated screening tool that can be easily incorporated into the primary care workflow. A PHQ-9 score of 10 or greater indicates the presence of clinically significant depressive symptoms.

For patients with a positive screening result, a comprehensive assessment should be performed to confirm the diagnosis of major depressive disorder (MDD) based on the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) criteria. This includes evaluating the duration, severity, and impact of depressive symptoms on the patient's daily functioning.

## Screening for Anxiety Disorders

Anxiety disorders, such as generalized anxiety disorder (GAD), panic disorder, and social anxiety disorder, are also highly prevalent in primary care. The Generalized Anxiety Disorder-7 (GAD-7) scale is a reliable and valid screening tool that can be used to identify patients with clinically significant anxiety symptoms. A GAD-7 score of 10 or greater suggests the presence of an anxiety disorder.

For patients with a positive screening result, a more detailed assessment should be conducted to determine the specific type of anxiety disorder and its impact on the patient's life. This may include a review of the patient's symptom history, associated functional impairment, and any co-occurring medical or psychiatric conditions.

## Initial Management of Depression and Anxiety

For patients diagnosed with MDD or an anxiety disorder, the primary care provider should initiate appropriate treatment, which may include a combination of pharmacotherapy and psychotherapy.

### Pharmacotherapy

The first-line pharmacological treatments for MDD in primary care include selective serotonin reuptake inhibitors (SSRIs), such as sertraline (starting dose 50 mg daily), fluoxetine (starting dose 20 mg daily), or escitalopram (starting dose 10 mg daily). These medications should be titrated gradually to the minimum effective dose, typically within 4-6 weeks.

For anxiety disorders, SSRIs or serotonin-norepinephrine reuptake inhibitors (SNRIs), such as venlafaxine (starting dose 37.5 mg twice daily) or duloxetine (starting dose 30 mg daily), are commonly used as first-line pharmacotherapy. Benzodiazepines, such as clonazepam or lorazepam, may be prescribed for short-term symptomatic relief, but their use should be limited due to the risk of dependence and withdrawal.

Patients should be monitored closely for medication side effects, which may include nausea, sexual dysfunction, or increased anxiety during the initial titration phase. Providers should also assess for any potential drug interactions, particularly with medications commonly prescribed in primary care, such as antihypertensives, anticoagulants, or diabetes medications.

### Psychotherapy

In addition to pharmacotherapy, evidence-based psychotherapies, such as cognitive-behavioral therapy (CBT) or interpersonal therapy (IPT), should be considered as part of the treatment plan for depression and anxiety disorders. Referral to a mental health specialist, such as a psychologist or licensed clinical social worker, may be necessary for the provision of these services.

## Monitoring and Follow-up

Patients diagnosed with depression or an anxiety disorder should be closely monitored for treatment response, medication adherence, and any emerging safety concerns. The PHQ-9 and GAD-7 scales can be used to track symptom severity and guide treatment adjustments.

Patients should be scheduled for follow-up visits within 1-2 weeks of initiating or changing medication, and then at regular intervals (e.g., every 4-6 weeks) until symptoms are well-controlled. During these visits, providers should assess for any changes in symptom severity, side effects, and functional impairment.

## Referral to Specialty Mental Health Care

Patients who do not respond to initial treatment, experience significant functional impairment, or have co-occurring mental health or substance use disorders may require referral to a mental health specialist, such as a psychiatrist or psychologist, for more comprehensive evaluation and management.

Criteria for referral may include:
- Failure to achieve remission after an adequate trial of first-line pharmacotherapy and psychotherapy
- Presence of psychotic symptoms, bipolar disorder, or other complex psychiatric conditions
- Significant suicidal ideation or risk of self-harm
- Co-occurring substance use disorder or other medical/psychiatric comorbidities

Effective communication and coordination of care between the primary care provider and the mental health specialist is essential to ensure continuity of care and optimal patient outcomes.

## Conclusion

The early identification and management of mental health conditions, such as depression and anxiety disorders, is a critical component of comprehensive primary care. By incorporating standardized screening tools, evidence-based treatment approaches, and collaborative care models, primary care providers can play a vital role in improving the mental health and overall well-being of their patients.