Adults aged 18 years and older should be screened for depression, including older adults and pregnant/postpartum women, according to updated guidelines from the U.S. Preventive Services Task Force (USPSTF).
The USPSTF has determined that there is significant evidence that screening all adults for depression in primary care settings improves accurate diagnosis and treatment.
Commonly used screening tools include:
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- Patient Health Questionnaire
- Hospital Anxiety and Depression Scales
- Geriatric Depression Scale
- Edinburgh Postnatal Depression Scale
If a patient screens positively, he or she is advised to undergo additional assessments to examine depression severity, comorbid psychological conditions, alternative diagnoses, and medical conditions.
For patients diagnosed with depression, treatments include antidepressants or various types of psychotherapy, including cognitive behavioral therapy and brief psychosocial counseling. Because antidepressants can potentially harm fetuses, the USPSTF recommends psychotherapy rather than pharmacotherapy for pregnant and postpartum women with depression.
To maximize the benefits of these screenings, the USPSTF recommends that primary care facilities have “adequate systems in place,” meaning that facilities should have the necessary systems and clinical staff to ensure that adults are screened for depression. For a positive screening, facilities should be equipped to either properly diagnosis and treat the patient or refer him or her to a setting that can do so.
To help patients manage depression, the USPSTF notes the efficacy of multidisciplinary, team-based primary care that includes self-management support and care coordination.
The USPSTF did not find enough evidence to recommend the optimal timing and interval for depression screenings. Until more research is done, the organization recommends screening all adults who have never been screened and using clinical judgment to determine if additional screening is needed.
In a related editorial, Charles F. Reynolds III, MD, and Ellen Frank, PhD, commented, “[The USPSTF recommendation statement] does not in our view place adequate emphasis on major depression as a recurring, chronic condition in the majority of patients. Simply stated, it is not enough to get well – staying well is also important.”
To see the USPSTF’s full depression screening recommendations for adults as well as their recommendations for children and adolescents, visit http://www.uspreventiveservicestaskforce.org/.
References
- Siu AL and the U.S. Preventive Services Task Force (USPSTF). Screening for Depression in Adults: US Preventive Services Task Force Recommendation Statement. JAMA. 2016;315(4):380-387. doi:10.1001/jama.2015.18392.
- Reynolds CF III, Frank E. US Preventive Services Task Force Recommendation Statement on Screening for Depression in Adults: Not Good Enough. JAMA Psychiatry. Published online January 26, 2016; doi:10.1001/jamapsychiatry.2015.3281.
- Whooley MA. Screening for Depression – A Tale of Two Questions. JAMA Intern Med. Published online January 26, 2016; doi:10.1001/jamainternmed.2015.8493.
