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Screening for Depression in Adults: U.S. Preventive Services Task Force Recommendations FREE

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The summary below is from the full reports titled “Screening for Depression in Adults: U.S. Preventive Services Task Force Recommendation Statement” and “Screening for Depression in Adult Patients in Primary Care Settings: A Systematic Evidence Review.” They are in the 1 December 2009 issue of Annals of Internal Medicine (volume 151, pages 784-792 and pages 793-803). The author of the first report is the U.S. Preventive Services Task Force; the authors of the second report are E.A. O'Connor, E.P. Whitlock, T.L. Beil, and B.N. Gaynes.


Ann Intern Med. 2009;151(11):I-56. doi:10.7326/0003-4819-151-11-200912010-00002
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Who developed these guidelines?

The U.S. Preventive Services Task Force (USPSTF) is a group of health experts that reviews published research and makes recommendations about preventive health care.

What is the problem and what is known about it so far?

Depression is characterized by persistent sadness and hopelessness that interferes with daily life. Depression goes beyond a normal reaction to a life situation. It persists for months or even years and can affect a person's work, relationships with family and friends, sleep and eating habits, ability to complete the regular tasks of everyday life, and general health. About 1 of every 5 persons has depression at some time in his or her life. Depression is common among patients who see primary care doctors. Common depression symptoms are lack of energy and loss of interest in things previously enjoyed. Sometimes depression goes away on its own, but many depressed persons need treatment with counseling or medication to speed recovery. Often, persons with depression do not realize that their feelings are due to a medical condition and do not seek medical care.

Some experts think that doctors should screen patients for depression. Screening involves looking for a disease in persons who do not report symptoms. Patients found through screening can begin treatment. We know that depression is common and that asking patients about sad feelings can identify those with depression. However, it is not clear whether screening for depression by routinely asking patients about symptoms improves patient outcomes. In 2002, the USPSTF found limited evidence on how well screening for depression works when doctors do not have tools to help improve diagnosis and treatment and allow appropriate follow-up. There was little information about which screening questions work best and how often they should be asked. The USPSTF therefore reviewed research published since the 2002 recommendation to see whether more definitive information about the benefits and harms of depression screening is available.

How did the USPSTF develop these recommendations?

The USPSTF reviewed research published since 2002 and combined it with the evidence included in the 2002 review to evaluate the benefits and harms of screening for depression.

What did the authors find?

Good evidence suggests that screening improves the accurate identification of patients with depression in primary care settings. Screening works best when doctors' offices have systems in place to support accurate diagnosis, prescription of effective treatment, and careful follow-up of depressed patients. Patients are unlikely to benefit from screening if such systems are not in place.

What does the USPSTF recommend that patients and doctors do?

Doctors who have programs in place to ensure accurate diagnosis and provide effective treatment with careful monitoring and follow-up within their practices should screen patients for depression. If a doctor cannot offer patients this type of care, then screening programs are not likely to improve patients' outcomes.

What are the cautions related to these recommendations?

The risk for serious adverse events from treatment with antidepressants is increased in some populations. Careful monitoring and follow-up is especially important for patients who are prescribed antidepressants. Patients who have unexplained sadness, lack of interest in life, constant “blue mood,” and low energy should tell their doctors about these symptoms.

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