This series of fact sheets is based on the work of the U.S. Preventive Services Task Force (USPSTF). The USPSTF systematically reviews the evidence of effectiveness of a wide range of clinical preventive services—including screening, counseling, and chemoprevention (the use of medication to prevent diseases)—to develop recommendations for preventive care in the primary care setting.
This fact sheet presents highlights of USPSTF recommendations on this topic and should not be used to make treatment or policy decisions. More detailed information on this subject is available from the USPSTF and the May 21, 2002, issue of the Annals of Internal Medicine 136(10):765-76.
Depression is a disabling illness especially common among primary care patients. Between 5 percent and 9 percent of adult patients in primary care suffer from depression and up to 2 percent of children and 4 percent of adolescents suffer from this illness. Depression increases health care utilization and costs $17 billion in lost workdays each year.
Women, those with a family history of depression, the unemployed, and those with chronic disease are at increased risk for depression. However, the presence of these risk factors alone cannot distinguish which patients are likely to have depression.
Despite its high prevalence in primary care and its substantial economic impact, depression often goes unrecognized in the primary care setting. Patients whose depression is undetected cannot be treated appropriately.
The current U.S. Preventive Services Task Force (USPSTF) recommends screening adults for depression in clinical practices that have systems in place to assure accurate diagnosis, effective treatment, and careful followup. Benefits from screening are unlikely to be realized unless such systems are functioning well.
Many tools to screen for depression are available, and there is little evidence to recommend one over another. Clinicians can choose the tools that they prefer, and those that best fit their patient population and practice setting. Asking the following two questions may be as effective as using longer screening instruments:
Adults should be screened for depression when accurate diagnosis, effective treatment, and careful followup can be assured.
All positive screening tests should trigger full diagnostic interviews that use standard diagnostic criteria (for example, the Diagnostic and Statistical Manual of Mental Disorders , Fourth Edition [DSM-IV]) to determine the presence or absence of specific depressive disorders.
The USPSTF identified randomized, controlled trials examining the effectiveness of screening for depression in primary care settings. Some examined the effectiveness of screening patients and providing feedback on the screening to clinicians. The combination of screening and feedback generally increased clinicians' recognition of depression. The combination of screening and feedback alone, however, had no significant effect on the number of patients who received treatment for depression. When feedback was combined with treatment advice or other system supports, the number of patients treated for depression increased. Patient outcomes improved significantly when recognition and management programs were integrated into usual care. Integrated programs included feedback, provider and/or patient education, access to case management and/or mental health care, telephone followup, and institutional commitment to quality improvement.
The USPSF concludes the evidence is insufficient to recommend for or against routine screening of children or adolescents for depression. Although depression also affects these patient groups and can be treated effectively, the clinical impact of routine depression screening has not been studied in pediatric populations in primary care settings. Clinicians should remain alert for possible signs of depression in younger patients.
Patient outcomes improve significantly when depression recognition and management are integrated into usual care.
In 1996, the USPSTF found insufficient evidence to recommend for or against routine screening for depression using standardized questionnaires. At that time, the USPSTF found no clear evidence that screening patients in primary care settings led to better health outcomes.
For more information on screening and treatment for depression, contact the following organizations:
healthfinder®
http://www.healthfinder.gov
National Institute of Mental Health
http://www.nimh.nih.gov
More detailed information on this subject is available:
Members of the USPSTF represent the fields of family medicine, gerontology, obstetrics-gynecology, pediatrics, nursing, prevention research, and psychology. Members of the USPSTF are:
Alfred O. Berg, M.D., M.P.H., Chair
Janet D. Allan, Ph.D., R.N., C.S., Vice-chair
Paul S. Frame, M.D.
Charles J. Homer, M.D., M.P.H.
Mark S. Johnson, M.D., M.P.H.
Jonathan D. Klein, M.D., M.P.H.
Tracy A. Lieu, M.D., M.P.H.
Cynthia D. Mulrow, M.D., M.Sc.
Carole Tracy Orleans, Ph.D.
Jeffrey F. Peipert, M.D., M.P.H.
Nola J. Pender, Ph.D., R.N.
Albert L. Siu, M.D., M.S.P.H.
Steven M. Teutsch, M.D., M.P.H.
Carolyn Westhoff, M.D., M.Sc.
Steven H. Woolf, M.D., M.P.H.
AHRQ Publication No. APPIP02-0019
Current as of May 2002
Internet Citation:
Screening for Depression . What's New from the USPSTF. AHRQ Publication No. APPIP02-0019, May 2002. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/clinic/3rduspstf/depression/depresswh.htm
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