Michael P. Pignone, MD, MPH; Bradley N. Gaynes, MD, MPH; Jerry L. Rushton, MD, MPH; Catherine Mills Burchell, MA; C. Tracy Orleans, PhD; Cynthia D. Mulrow, MD, MSc; Kathleen N. Lohr, PhD
Disclaimer: The authors of this article are responsible for its contents, including any clinical or treatment recommendations. No statement in this article should be construed as an official position of the Agency for Healthcare Research and Quality or the U.S. Department of Health and Human Services.
Acknowledgments: The authors thank David Atkins, MD, MPH, Director, AHRQ Clinical Prevention Program; Eve Shapiro, AHRQ consulting editor; and Sonya Sutton, BSPH, Sheila White, and Loraine Monroe of Research Triangle Institute for assistance. They also thank Christopher Phillips, MD, MPH, from the Office for Prevention and Health Services Assessment, Air Force Medical Operations Agency, San Antonio, Texas, for help with preparation of the meta-analysis figures.
Grant Support: This study was developed by the Research Triangle Institute–University of North Carolina Evidence-based Practice Center under contract to the Agency for Healthcare Research and Quality (contract no. 290-97-0011), Rockville, Maryland.
Requests for Single Reprints: Reprints are available from the Agency for Healthcare Research and Quality Web site (www.ahrq.gov/clinic/uspstfix.htm) or the Agency for Healthcare Research and Quality Publications Clearinghouse (800-358-9295).
Current Author Addresses: Dr. Pignone: 5039 Old Clinic Building, University of North Carolina Hospitals, Chapel Hill, NC 27514.
Dr. Gaynes: 240 Medical School Wing C, CB #7160, University of North Carolina Hospitals, Chapel Hill, NC 27514.
Dr. Rushton: Division of General Pediatrics, University of Michigan, 300 North Ingalls Building, Room 6D05, Ann Arbor, MI 48109-0456.
Dr. Orleans: Robert Wood Johnson Foundation, Route 1 and College Road East, Princeton, NJ 08543.
Ms. Burchell: 223 Joicey Boulevard, Botonto, Ontario M5M 2V4, Canada.
Dr. Mulrow: The University of Texas Health Science Center, San Antonio, 7400 Merton Minter Boulevard (11C6), San Antonio, TX 78284.
Dr. Lohr: Research Triangle Institute, 3040 Cornwallis Road, Research Triangle Park, NC 27709.
To clarify whether screening adults for depression in primary care settings improves recognition, treatment, and clinical outcomes.
The MEDLINE database was searched from 1994 through August 2001. Other relevant articles were located through other systematic reviews; focused searches of MEDLINE from 1966 to 1994; the Cochrane depression, anxiety, and neurosis database; hand searches of bibliographies; and extensive peer review.
The researchers reviewed randomized trials conducted in primary care settings that examined the effect of screening for depression on identification, treatment, or health outcomes, including trials that tested integrated, systematic support for treatment after identification of depression.
A single reviewer abstracted the relevant data from the included articles. A second reviewer checked the accuracy of the tables against the original articles.
Compared with usual care, feedback of depression screening results to providers generally increased recognition of depressive illness in adults. Studies examining the effect of screening and feedback on treatment rates and clinical outcomes had mixed results. Many trials lacked power to detect clinically important differences in outcomes. Meta-analysis suggests that overall, screening and feedback reduced the risk for persistent depression (summary relative risk, 0.87 [95% CI, 0.79 to 0.95]). Programs that integrated interventions aimed at improving recognition and treatment of patients with depression and that incorporated quality improvements in clinic systems had stronger effects than programs of feedback alone.
Compared with usual care, screening for depression can improve outcomes, particularly when screening is coupled with system changes that help ensure adequate treatment and follow-up.
Table 1. Characteristics of Case-Finding Instruments Used To Detect Depression in Adults in Primary Care Settings
Table 2. Studies on the Effect of Screening and Feedback
Table 3. Summary of the Effect of Feedback from Screening on Rates of Diagnosis
Table 4. Summary of the Effect of Feedback from Screening on Rates of Treatment
Table 5. Summary of the Effect of Feedback from Screening on Patient Outcomes
Meta-analysis of the effect of screening and feedback on the proportion of patients with persistent depression.Top.Bottom.
Meta-analysis of the effect of screening and feedback on the proportion of patients with persistent depression, excluding the study by Katzelnick and colleaguesTop.Bottom.
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Pignone MP, Gaynes BN, Rushton JL, Burchell CM, Orleans CT, Mulrow CD, et al. Screening for Depression in Adults: A Summary of the Evidence for the U.S. Preventive Services Task Force. Ann Intern Med. 2002;136:765–776. doi: 10.7326/0003-4819-136-10-200205210-00013
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Published: Ann Intern Med. 2002;136(10):765-776.
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