Depression Awareness Month is an opportunity to look beyond screening rates and ask whether screening is improving care.

Nearly 20 million U.S. adults experienced a major depressive episode in 2025, according to the newly released National Survey on Drug Use and Health (NSDUH). Among young adults ages 18–25, the rate was particularly striking: 14.2% experienced a major depressive episode, and 10.2% experienced one with severe impairment.

Depression also frequently intersects with other behavioral health needs. Of the 19.7 million adults who experienced a major depressive episode in 2025, 7.3 million also had a substance use disorder. There is some encouraging news. The percentage of adults experiencing a major depressive episode declined from 2024 to 2025.

So, during Depression Awareness Month, what should behavioral health leaders take from these numbers?

Probably not that we need another reminder to screen for depression.

Screening is already firmly embedded in healthcare practice and quality measurement. CMS continues to maintain a quality measure for depression screening and follow-up, including within its Mental/Behavioral Health specialty measure set. The 2026 CMS measure evaluates both the use of an age-appropriate standardized depression screening tool and documented follow-up when the screen is positive.

Depression Screening and Suicide Risk Are Not the Same Thing

This is an important distinction. A depression screening tool identifies symptoms associated with depression. It does not replace a suicide screen or risk assessment.

Depression can include thoughts of death or suicide, but not every client with depression is suicidal, and suicide risk is not limited to clients with depression. NIMH identifies thoughts of death or suicide as one possible symptom of depression, along with hopelessness, loss of interest, sleep and appetite changes, difficulty concentrating, withdrawal, increased substance use, and impaired daily functioning.

The operational issue is whether staff know when a finding on a depression screen requires another clinical step.

A positive depression screen should lead to the appropriate clinical response. A response indicating thoughts of self-harm or suicide may trigger a different pathway based on the organization’s suicide risk assessment process.

Those pathways should be clear to staff—and visible in the clinical record.

Follow the Positive Screen

One of the simplest ways to evaluate your process is to stop auditing only whether the depression screen was completed.

Instead, select a sample of positive depression screens and follow them through the clinical record.

• Was the result recognized and evaluated?
• Did the identified needs make their way into the treatment plan?
• Was treatment initiated or modified?
• If additional services or referrals were indicated, did they occur?
• When findings suggested possible suicide risk, was the organization’s suicide risk process initiated?

Finding a completed depression screen in the clinical record tells you that the first step occurred. It doesn’t tell you whether the organization responded appropriately to the result.

That distinction is also reflected in CMS quality measurement. CMS’s current depression measure doesn’t stop with completion of the screening tool. For a positive screen, the measure looks for a documented follow-up plan.

Are You Using Depression Measures to Determine Whether Treatment Is Working?

There is another opportunity for behavioral health organizations.

Don’t view standardized depression tools solely as screening instruments. When clinically appropriate, repeated measures can help clinicians evaluate changes in symptoms and response to treatment.

Many organizations already have considerable data available to them. The question is whether anyone is using it. Rather than adding another measure to the dashboard, consider what you can learn from the information you already collect:

• Look at changes in scores over time.
• Identify clients who aren’t improving as expected.
• Look for variation among programs, populations, clinicians, or levels of care.

Then connect those findings back to clinical practice and performance improvement.

The goal isn’t to collect more data. It is to make better use of the data you already collect.

That is particularly relevant as the behavioral health field continues to emphasize measurement-based care—using standardized information about symptoms and outcomes to help inform treatment decisions rather than relying solely on periodic screening or clinician impression.

Use Depression Awareness Month to Test the Process

Rather than another educational campaign reminding staff to complete depression screens, October may be a good time to test whether your existing process actually works.

Take a small sample of positive screens from several programs or locations and trace them forward. Look for the connection between the screening result, additional assessment when indicated, treatment planning, intervention, follow-up, and subsequent evaluation of the client’s response.

Then look across the cases. Here’s what you may find:

• Screening-completion rates are excellent but follow-up varies by program
• Referrals are ordered but never completed
• Scores are collected but there is no evidence that clinicians use changes in those scores to inform treatment

Those findings tell leadership considerably more than a dashboard showing a 98% screening-completion rate.

Key Takeaway

A high depression-screening rate does not necessarily mean you have a strong depression-screening program. The real measure of the process is what happens after the screen.

Organizations should be able to demonstrate that a positive finding is recognized, evaluated, connected to treatment when appropriate, and followed over time to determine whether the client is improving.

The Barrins Perspective

Depression screening is a good example of why quality measurement, accreditation compliance, and clinical practice should not operate separately.

On our consultations, we recommend looking beyond whether the required screening tool is present. Trace the result into care. The strongest process connects screening, assessment, treatment planning, intervention, and outcomes in a way that is apparent both clinically and in the record.

Next Steps

This Depression Awareness Month, select 10 positive depression screens and follow them through the clinical record.

Don’t just ask whether the screen was completed. Determine whether the result influenced what happened next—and whether your organization can demonstrate that connection.

Barrins & Associates can help behavioral health organizations evaluate these processes through clinical tracers, mock surveys, and continuous-readiness consultations. Contact us to learn more.

Frequently Asked Questions

Does a depression screening tool replace a suicide risk assessment?

No. A depression screen identifies symptoms associated with depression, but it doesn’t replace a suicide screen or risk assessment. Not every client with depression is suicidal, and suicide risk isn’t limited to clients with depression. When a screen shows thoughts of self-harm or suicide, the organization’s suicide risk assessment process should be triggered.

What does CMS require for depression screening and follow-up?

CMS’s depression screening quality measure looks at two things: whether an age-appropriate standardized screening tool was used, and whether a follow-up plan was documented when the screen is positive. Completing the screening tool on its own doesn’t satisfy the measure.

How can we tell whether our depression screening process is working?

Don’t audit only whether screens were completed. Pick a sample of positive screens and follow each one through the clinical record. Check whether the result was evaluated, reflected in the treatment plan, and acted on, and whether referrals and any suicide risk steps actually happened.

What is measurement-based care in behavioral health?

Measurement-based care uses standardized information about symptoms and outcomes to help guide treatment decisions, instead of relying only on periodic screening or clinician impression. Repeating depression measures over time can show whether a client’s treatment is working.

How many records should we review for a depression screening tracer?

Ten positive screens is a practical starting point. Pull them from several programs or locations so you can compare follow-up practices across the organization.