What's New From the USPSTF
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.
How Common Is Depression In Primary Care?
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.
Does the USPSTF Recommend Screening Primary Care Patients for Depression?
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:
- Over the past 2 weeks, have you ever felt down,
depressed, or hopeless?
- Over the past 2 weeks, have you felt little interest or
pleasure in doing things?
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.
How Does This USPSTF Recommendation Differ from Its Previous Position?
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
Detailed Information
More detailed information on this subject is available:
USPSTF Members
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
540 Gaither Road Rockville, MD 20850