• All adults should be screened for depression

    The USPSTF has released its first recommendation to screen adults for depression. Should we screen? Let’s run through my rules.

    (1) Is the condition prevalent and severe enough to warrant screening?

    Depression is among the leading causes of disability in persons 15 years and older. It affects individuals, families, businesses, and society and is common in patients seeking care in the primary care setting. Depression is also common in postpartum and pregnant women and affects not only the woman but her child as well.

    (2) Do we have a cost-effective means to screen the general population?

    The USPSTF found convincing evidence that screening improves the accurate identification of adult patients with depression in primary care settings, including pregnant and postpartum women.

    (3) Does early diagnosis make a difference (that is, do we have treatments available that are more successful when patients are diagnosed earlier?)

    The USPSTF found adequate evidence that programs combining depression screening with adequate support systems in place improve clinical outcomes (ie, reduction or remission of depression symptoms) in adults, including pregnant and postpartum women.

    The USPSTF found convincing evidence that treatment of adults and older adults with depression identified through screening in primary care settings with antidepressants, psychotherapy, or both decreases clinical morbidity.

    The USPSTF also found adequate evidence that treatment with cognitive behavioral therapy (CBT) improves clinical outcomes in pregnant and postpartum women with depression.

    (4) Will an early diagnosis motivate people to use information gained from screening?

    The USPSTF concludes with at least moderate certainty that there is a moderate net benefit to screening for depression in adults, including older adults, who receive care in clinical practices that have adequate systems in place to ensure accurate diagnosis, effective treatment, and appropriate follow-up after screening. The USPSTF also concludes with at least moderate certainty that there is a moderate net benefit to screening for depression in pregnant and postpartum women who receive care in clinical practices that have CBT or other evidence-based counseling available after screening.

    That nets you a “B” from the USPSTF. You’ll get no argument from me.

    @aaronecarroll

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