U.S. Preventive Services Task Force
Update of the 2002 U.S. Preventive Services Task Force (USPSTF) recommendation statement on screening for depression in adults.
The USPSTF examined evidence on the benefits and harms of screening primary care patients for depression, including direct evidence that depression screening programs improve health outcomes. The USPSTF did not reexamine evidence for those key questions that had strong, consistent evidence in the 2002 review, including questions about the accuracy of screening instruments in identifying depressed adult patients in primary care settings, and the efficacy of treatment of depressed adults with antidepressants or psychotherapy. New areas of evidence considered for this review (and not reviewed in 2002) include efficacy of treatment of depression in older adult patients, harms of screening for depression in primary care settings, and adverse events from treatment of depression in adults.
The USPSTF recommends screening adults for depression when staff-assisted depression care supports are in place to assure accurate diagnosis, effective treatment, and follow-up. (Grade B recommendation)
The USPSTF recommends against routinely screening adults for depression when staff-assisted depression care supports are not in place. There may be considerations that support screening for depression in an individual patient. (Grade C recommendation)
For a summary of the evidence systematically reviewed in making these recommendations, the full recommendation statement, and supporting documents, please go to www.preventiveservices.ahrq.gov.
* See the Suggestions for Practice section of this figure for further explanation.
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James H. Scully
American Psychiatric Association
January 8, 2010
Caution Urged in Interpreting New USPSTF Guidelines on Screening for Depression in Primary Care Settings
The American Psychiatric Association (APA) cautions against misunderstanding or misuse of the updated guidelines on screening for depression in primary care settings developed by the U.S. Preventative Services Task Force (USPSTF) (1). The guidelines recommend routine screening of adults for depression only when the primary care setting includes support staff to assure accurate diagnosis, effective treatment, and follow-up. When support staff are not present, the guidelines recommend against routine screening.
APA is concerned that health systems or doctors may misinterpret the latter recommendation as justification to avoid screening or management of depression in primary care settings. Good primary care of adults should include the recognition and management of depression, no less so than hypertension or diabetes.
As noted in the USPSTF guidelines, depression is among the leading causes of disability in adults and is common in primary care patients. Furthermore, the utility of depression screening in adults has been demonstrated by several well-designed studies, cited in the USPSTF guidelines. In these studies, universal screening was just one component of a comprehensive program for depression care that also included integrated assessment and treatment by dedicated support staff, as well as appropriate follow-up.
Many primary care practices lack support staff to implement such programs. A recent study (2) showed that less than a third of primary care physicians use nurse practitioners to coordinate care for chronic conditions, and the adoption rate is even less for small practices. However, we don't see a recommendation against primary care physicians screening for hypertension, diabetes, or other chronic conditions which require careful follow-up and care coordination. APA affirms that the prevalence and impact of depression require that primary care physicians identify it and assure that patients receive adequate treatment and follow -up, either by the primary care physician or by referral to a psychiatrist or other mental health professional.
Effective treatments for depression are available, including antidepressant medications, depression-focused psychotherapies, and ECT. Patients should expect that decisions to identify and manage this disabling chronic disease are based on clinical judgment and not considerations of practice size or organizational structure.
1. US Preventive Services Task Force. Screening for breast cancer: U.S. Preventive Services Task Force Recommendation Statement. Ann Intern Med. 2009; 151(10):716-26.
2. Carrier E and Reschovsky J. Expectations outpace reality: physicians' use of care management tools for patients with chronic conditions. Issue Brief 129. Washington, DC: Center for Studying Health System Change; 2009.
U.S. Preventive Services Task Force. Screening for Depression in Adults: U.S. Preventive Services Task Force Recommendation Statement. Ann Intern Med. ;151:784–792. doi: 10.7326/0003-4819-151-11-200912010-00006
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Published: Ann Intern Med. 2009;151(11):784-792.
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