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New Recommendations for Depression Screening

The USPSTF recommends that adult patients be screened for depression in primary care practices.

The third U.S. Preventive Services Task Force (USPSTF) has been releasing new and updated guidelines during the past year (guidelines homepage; Journal Watch May 15 2001; Journal Watch Mar 19 2002).

USPSTF 3 concludes each of its guidelines with a recommendation, graded as follows:

A -- The intervention is strongly recommended.

B -- The intervention is recommended.

C -- The USPSTF makes no recommendation for or against the intervention.

D -- The intervention is not routinely recommended.

I -- Evidence is insufficient to recommend for or against the intervention.

In contrast to its 1996 findings, the USPSTF now finds good evidence that screening for depression in primary care practices can improve clinical outcomes in adult patients. The method of depression screening can range from structured written questionnaires to simply asking 2 questions: 1 about mood ("Over the past 2 weeks, have you felt down, depressed, or hopeless?") and 1 about anhedonia ("Over the past 2 weeks, have you felt little interest or pleasure in doing things?"). Recommendation: B

An accompanying meta-analysis of 14 randomized controlled trials conducted from 1994 through 2001 provided minimal evidence that screening alone, with feedback of only the results to the provider, improved outcomes; screening programs that were integrated with structured outreach, patient and physician interventions, and systemic quality improvement conferred even more benefit. Eleven patients would have to be identified as depressed and would have to be treated in order for 1 patient to experience significant improvement: With a prevalence of significant depression of about 10% in primary care practices, 110 patients would have to be screened to benefit 1 patient.

The USPSTF found no evidence to support or oppose screening for depression in children. Recommendation: I

Comment: The large number of patients that physicians will need to screen to benefit 1 patient (with a screening time of 1 to 5 minutes per patient), and the necessity of practice-based interventions and case management, will restrain many physicians from implementing this recommendation. However, a more focused case-finding strategy in patients with risk factors or with clinical presentations that suggest depression would be effective and would be a more acceptable approach. The full text of the original articles is available on the Agency for Healthcare Research and Quality website at http://www.ahrq.gov/clinic/3rduspstf/depression/ free of charge.

— Thomas L. Schwenk, MD

Published in Journal Watch General Medicine June 4, 2002

Citation(s):

U.S. Preventive Services Task Force. Screening for depression: Recommendations and rationale. Ann Intern Med 2002 May 21; 136:760-4.

• Medline abstract (Free)

Pignone MP et al. Screening for depression in adults: A summary of the evidence for the U.S. Preventive Services Task Force. Ann Intern Med 2002 May 21; 136:765-76.

• Medline abstract (Free)

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