Mental Health Awareness Month is an opportunity to pause and refocus on the role mental health plays in overall health outcomes, particularly in primary care.

Primary care providers and pediatricians are often the first and most consistent point of contact for patients experiencing depression, even when mental health is not the reason for the visit. Symptoms frequently surface during routine care through concerns such as fatigue, sleep disturbances, headaches, changes in appetite, or behavioral changes in children and adolescents.

Because of this, depression screening is a natural extension of whole-person care and an important tool for identifying concerns early, supporting timely intervention, and improving long-term outcomes for patients and families.

Why depression screening belongs in routine visits

Primary care settings are often where depression is first identified, sometimes before patients seek or access specialty behavioral health care. National clinical guidance supports depression screening beginning in adolescence and emphasizes the role of primary care in early identification and follow-up.

Depression screening commonly takes place during:

• Annual wellness visits.
• Chronic condition check-ins.
• Adolescent well visits.
• Visits for nonspecific or unexplained symptoms.

Depression frequently presents indirectly in these settings. Integrating brief, evidence-based screening into routine visits helps normalize mental health conversations, reduce stigma, and support earlier identification and better outcomes for patients and families.

Opening the conversation

While several formal screening tools are available, many providers begin with two brief, preliminary questions, commonly referred to as the Patient Health Questionnaire-2 (PHQ-2), to help determine whether further assessment may be helpful.

These questions are:

• Over the past two weeks, have you felt down, depressed, or hopeless?
• Over the past two weeks, have you felt little interest or pleasure in doing things?

These questions are not diagnostic and are designed to be quick, nonstigmatizing, and easy to integrate into busy primary care workflows. A “yes” response to either question may indicate that a more complete screening is appropriate.

Beyond initial screening

When initial screening suggests further evaluation may be helpful, a Patient Health Questionnaire-9 (PHQ‑9) screening form or an age‑appropriate pediatric screening tool can support a more detailed assessment. These tools can help providers assess symptom severity, monitor symptoms over time, support treatment decisions, and document clinical rationale for care.

In pediatric settings, depression screening often includes developmental context and caregiver input. Using validated tools can help support consistent assessment and follow‑up across both primary care and pediatric visits.

Treatment and follow-up

When depression is identified in the primary care setting, next steps may vary based on individual patient needs and clinical judgment. Care may include:

• Medication initiation and management, when clinically appropriate.
• Brief counseling strategies or motivational interviewing.
• Referral to behavioral health specialists.
• Ongoing symptom monitoring over time.

Reimbursement considerations

Depression is frequently identified and treated in the medical care setting, and primary care providers and pediatricians play an important role in evaluating, diagnosing, and managing depression when appropriate.

Claims for office visits related to medication management with a behavioral diagnosis that are billed by an in-network provider are considered for reimbursement under medical benefits. Providers should submit claims using the appropriate medical Current Procedural Terminology evaluation and management code. This policy does not apply when services are covered under a capitation arrangement.

Using validated screening tools and maintaining appropriate documentation can support clinical decision-making and help demonstrate medical necessity when depression is identified and treated in primary care.

Available resources

The following nationally recognized tools are commonly used in primary care and pediatric settings to support depression screening, documentation, and follow‑up:

• PHQ-9
• Mental Health Tools for Pediatrics (American Academy of Pediatrics)
• Bright Futures Toolkit: Commonly Used Screening Instruments

These resources are designed to integrate into routine visits and support clinical decision-making across patient populations.