Depression screening is effective only with follow-up

Clinical question Should clinicians screen adults for depression?

Bottom line The US Preventive Services Task Force (USPSTF) recommends screening for depression only if your office uses a team approach with office staff other than the physician available to provide case support, case management, or mental health treatment (grade B recommendation: moderate certainty of moderate benefit). Screening programs without such supports have not been shown to be effective and are not recommended (grade C recommendation: moderate evidence of a small net benefit). (Level of evidence = 1a)

Synopsis Screening programs for depression involve routine assessment of patients without obvious symptoms to determine whether a more formal diagnostic work-up is required. In the case of depression screening, its effectiveness is closely tied to the implementation of effective treatment—it does not make sense to identify patients who are depressed without having resources to adequately treat them. Therefore, the USPSTF evaluated whether screening for depression results in reduced morbidity and/or mortality. Citing nine fair- or good-quality trials, the group recommends screening only if “staff-assisted depression care supports” are in place. At a minimum, this support should include a nurse who performs the screening and a protocol to facilitate referral to behavioral treatment. Additional support includes staff and clinician development courses, monthly training lectures, visiting nurse ongoing support and assessment, a visit with a trained therapist, and nurse visits between physician visits. Formal instruments can be used for screening, although the task force points out that a two-question screen is just as effective. The two questions are: (1) “Over the past 2 weeks, have you felt down, depressed, or hopeless?” and (2) “Over the past 2 weeks, have you felt little interest or pleasure in doing things?” Positive results of screening warrant further evaluation for depression.

US Preventive Services Task Force. Screening for depression in adults: U.S. Preventive Services Task Forces recommendation statement. Ann Intern Med. 2009;151(11):784-792. O'Connor EA, Whitlock EP, Beil TL, Gaynes BN. Screening for depression in adult patients in primary care settings: a systematic evidence review. Ann Intern Med. 2009;151(11):793-803.