The U.S. Preventive Services Task Force now finds sufficient evidence to encourage primary care clinicians to screen their adult patients for depression. Formal screening can make it easier to identify depression, a common and treatable condition that often is not recognized by patients or their doctors. At the same time, the Task Force noted that clinicians should have systems in place to assure accurate diagnosis, effective treatment, and follow-up if patients are to benefit from screening.
This recommendation, which was published in the May 21 issue of the Annals of Internal Medicine, updates the Task Force's 1996 recommendation. In 1996, the Task Force identified depression as an important clinical problem and encouraged clinicians to remain alert for signs of depression in their patients, but it concluded there was insufficient evidence to recommend for or against regular formal screening. Since then, the Task Force has reviewed new evidence from randomized trials that tested various screening tools and interventions for depression. It found that patients fared best when clinicians recognized the symptoms of depression and made sure that patients received appropriate treatment.
Although there are many tools available to screen for depression, there is little evidence to recommend one over another. Clinicians can choose tools that are appropriate for their patients and practice setting. According to Task Force Chairman Dr. Alfred Berg, Chair of the Department of Family Medicine, University of Washington, Seattle, “Our panel found that asking two simple questions -- over the past 2 weeks, have you ever felt down, depressed, or hopeless, and have you felt little interest or pleasure in doing things -- may be as effective as using longer screening instruments.” An affirmative response to these questions may indicate the need for the use of more in-depth diagnostic tools.
The Task Force found that 5 percent to 9 percent of adult patients in primary care settings suffer from depression. Depression is often disguised by other problems, and up to 50 percent of these cases go undetected and therefore, untreated. Women, those with a family history of depression, the unemployed, and those with chronic disease are among those at increased risk for depression. Depression increases health care utilization and costs $17 billion in lost workdays each year.
The Task Force concluded that the evidence is insufficient to recommend for or against routine screening of children or adolescents for depression. Although up to 2 percent of children and 4.5 percent of adolescents in primary care settings suffer from depression, there is not enough research about screening or treating this population in the clinical setting. Clinicians should remain alert for possible signs of depression in younger patients. Research in progress at the Agency for Healthcare Research and Quality (AHRQ) will add to the currently limited evidence base for children and adolescents.
The Task Force, sponsored by AHRQ, is a panel of independent, private-sector experts in prevention and primary care. It based its conclusions on a report sponsored by AHRQ's Evidence-based Practice Center at RTI (Research Triangle Park, NC) and the University of North Carolina (Chapel Hill) School of Medicine. Depression is the eighth recommendation that the current Task Force has released.