Screening for Depression in Adults

James C. Coyne; Steven C. Palmer; Patricia A. Sullivan

doi:10.7326/0003-4819-138-9-200305060-00017

Letters |6 May 2003

Screening for Depression in Adults

James C. Coyne, PhD; Steven C. Palmer, PhD; Patricia A. Sullivan, PhD

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TO THE EDITOR:

Pignone and colleagues' call for routine screening of general medical patients for depression (1) contrasts with past conclusions that the strength of evidence is insufficient for such a recommendation. The discrepancy is explained by both a shift in the question being addressed and the kind of evidence considered. Rather than evaluating screening in routine care, Pignone and colleagues examined whether routine screening combined with enhanced routine care improves outcomes. Fully 84% of the weight of evidence in their key meta-analysis is carried by three studies. Two (2, 3) yielded null results, so the positive effect is entirely carried by the study by Wells and colleagues (4). Screening was only a small part of this study, which recruited highly committed practices and provided training to staff, training materials, academic detailing, and additional staff. Also, a request was made that appointments be scheduled within 2 weeks for patients identified as depressed, and practices were provided with tracking lists and assistance in initiating and continuing treatment, as well as access to medication follow-up and brief, structured psychotherapy.

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2003 American College of Physicians

Letters |6 May 2003

Screening for Depression in Adults

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Letters |6 May 2003

Screening for Depression in Adults

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