Table 2. Studies on the Effect of Screening and Feedback
Screening for Depression in Adults: Summary of the Evidence
| Author, Year (Reference) | Screening Instrument | Participants, n | Mode of Administration | Confirmatory Diagnostic Interview? | Feedback to Provider | Quality Rating1 | |
|---|---|---|---|---|---|---|---|
| Internal Validity | External Validity | ||||||
| Johnstone and Goldberg, 1976 (14) | GHQ | 119 | Self | Yes | Immediate feedback | Good | Fair |
| Moore et al., 1978 (15) | SDS | 212 | Self | No | Immediate written feedback | Good | Fair |
| Linn and Yager, 1980 (16) | SDS | 150 | Self | No | Immediate written feedback | Good | Good |
| Zung and King, 1983 (17) | SDS and immediate diagnostic interview | 49 | Psychiatrist | Yes2 | Immediate feedback | Fair | Poor |
| Magruder-Habib et al., 1990 (18) | SDS | 100 | Research assistant | Yes2 | Immediate written feedback | Good | Good |
| Callahan et al., 1994 (19) and 1996 (21) | CES-D | 175, 222 | Research assistant | Yes (HAM-D)2 | Feedback to schedule 3 additional visits within 3 months | Good | Fair |
| Dowrick, 1995 (20) | BDI | 116 | Self | No | Written feedback to provider 1 week after visit, plus chart note | Fair | Fair |
| Lewis et al., 1996 (22) | GHQ | 681 | Self | PROQSY group only | Immediate on GHQ results; participants asked to complete PROQSY and, if positive, to schedule follow-up in 1 week | Fair | Fair |
| Reifler et al., 1996 (23) | SDDS | 358 | Self | Yes3 | Providers given diagnostic worksheet at same visit for participants who screened positive | Good | Good |
| Williams et al., 1999 (11) | CES-D, blinded DSM-III-R | 969 | Self | Yes3 | Immediate written feedback | Good | Good |
| Katzelnick et al., 2000 (12) | SCID + HAM-D | 407 | Telephone by research assistant | No | Immediate written feedback and additional support | Good | Good |
| Wells et al., 2000 (24) | Two-item instrument | 1,356 | Research assistant | Yes (subset)3 | Providers notified and asked to schedule visit within 2 weeks | Good | Fair |
| Whooley et al., 2000 (25) | GDS | 2,346 | Research assistant | No | Intervention providers notified same day (before visit, 74%; after visit, 26%) | Fair | Fair |
| Rost et al., 2001 (13) | Sadness or anhedonia within 2 weeks | 479 (189 not recently treated) | Nurse | Yes | Feedback to provider; nurse-centered follow-up weekly for 5 weeks | Fair | Good |
Note: BDI indicates Beck Depression Inventory; CES-D, Center for Epidemiologic Study Depression scale; GDS, Geriatric Depression Scale; GHQ, General Health Questionnaire; PROSQY, self-administered computerized assessment; SDS, Zung Self-Depression Scale; SDDS, Symptom-Driven Diagnostic System for Primary Care.
1 The definitions of the quality ratings are as follows. Good: evidence includes consistent results from well-designed, well-conducted studies in representative populations that directly assess effects on health outcomes. Fair: Evidence is sufficient to determine effects on health outcomes, but the strength of the evidence is limited by the number, quality, or consistency of the individual studies, generalizability to routine practice, or indirect nature of the evidence on health outcomes. Poor: Evidence is insufficient to assess the effects on health outcomes because of limited number or power of studies, important flaws in their design or conduct, gaps in the chain of evidence, or lack of information on important health outcomes.
2 Required before randomization.
3 Not related to randomization.
