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screening for depression (includes depression assessment tools)

Indications: - USPSTF recommends screening all adults for depression provided that adequate resources are available for treatment (cognitive behavioral therapy) & follow-up [1,2,4] - USPSTF recommends screening pregnant & postpartum women [4] - USPSTF recommends screening for depression in the adult population, including pregnant & postpartum persons & older adults [7] - treating adults & older adults who have depression identified through routine screening decreases morbidity (see benefit/risk) - USPSTF recommends screening for major depression in adolescents 12-18 years of age when adequate systems are in place for diagnosis, treatment, & monitoring [5,6] - Beck Depression Inventory with highest sensitivity & specificity for screening adolescents [5] - patient health questionniare 9 (PHQ9) may be most widely used - patient health questionniare 2 (PHQ2) recommended in [1] - screening for depression with feedback does not improve outcomes [8] * USPSTF concludes that evidence is insufficient to assess the benefits vs harms of screening for major depression in children age 11 years & younger [5] Contraindications: - screening not recommended for children [2] Benefit/risk: - NNT = 110 - 1 of 11 patients identified by screening respond to treatment for depression - at a prevalence of 10% in the general adult population, 110 patients need to be screened for 1 to benefit - USPSTF claims that screening with adequate systems in place to ensure accurate diagnosis, effective treatment, & appropriate follow-up improves depressive symptoms in adults Management: - consider social determinants of health when screening for depression [9] - treatment with cognitive behavioral therapy improves clinical outcomes in pregnant & postpartum women [4]

Related

depression scale

Specific

Bech-Rafaelsen Depression Scale (BRDS) Beck Depression Inventory (BDI) Center for Epidemiological Studies-Depression Scale (CES-D) geriatric depression scale (GDS) Hamilton depression scale (HAM-D) Inventory for Depression Symptomatology-Clinician Rated (IDS-C) Montgomery-Asberg depression rating scale (MADRS) patient health questionniare 9 (PHQ9) two question depression screen Zung self-rating depression scale (ZSRDS)

General

cognitive assessment screening

References

  1. Medical Knowledge Self Assessment Program (MKSAP) 16, 19. American College of Physicians, Philadelphia 2012, 2021. - Medical Knowledge Self Assessment Program (MKSAP) 19 Board Basics. An Enhancement to MKSAP19. American College of Physicians, Philadelphia 2022
  2. US Preventive Services Task Force, Screening for Depression, Ann Intern Med 136:760, 2002 PMID: 12020146 - Pignone MP et al, Screening for depression in adults: a summary of the evidence for the U.S. Preventive Services Task Force. Ann Intern Med 136:765, 2002 PMID: 12020146 - O'Connor EA, Whitlock EP, Beil TL, Gaynes BN. Screening for depression in adult patients in primary care settings: a systematic evidence review. Ann Intern Med. 2009 Dec 1;151(11):793-803. PMID: 19949145 - corresponding NGC guideline withdrawn Dec 2014
  3. Maurer DM. Screening for depression. Am Fam Physician. 2012 Jan 15;85(2):139-44. PMID: 22335214
  4. USPSTF: Draft Recommendation Statement, Jan 2015. Depression in Adults: Screening http://www.uspreventiveservicestaskforce.org/Page/Document/draft-recommendation-statement115/depression-in-adults-screening1 - Siu AL for the US Preventive Services Task Force (USPSTF) USPSTF Recommendation Statement Screening for Depression in Adults. US Preventive Services Task Force Recommendation Statement. JAMA. 2016;315(4):380-387. PMID: 26813211 http://jama.jamanetwork.com/article.aspx?articleid=2484345 - O'Connor E et al Evidence Report for the USPSTF Primary Care Screening for and Treatment of Depression in Pregnant and Postpartum Women. Evidence Report and Systematic Review for the US Preventive Services Task Force. JAMA. 2016;315(4):388-406 PMID: 26813212 http://jama.jamanetwork.com/article.aspx?articleid=2484344 - Thase ME Recommendations for Screening for Depression in Adults. JAMA. 2016;315(4):349-350. PMID: 26813206 http://jama.jamanetwork.com/article.aspx?articleid=2484316
  5. Siu AL on behalf of the U.S. Preventive Services Task Force Screening for Depression in Children and Adolescents: U.S. Preventive Services Task Force Recommendation Statement. Ann Intern Med. Published online 9 February 2016 PMID: 26858097 http://annals.org/article.aspx?articleid=2490528 - Forman-Hoffman V, McClure E, McKeeman J et al Screening for Major Depressive Disorder in Children and Adolescents: A Systematic Review for the U.S. Preventive Services Task Force. Ann Intern Med. Published online 9 February 2016 PMID: 26857836 http://annals.org/article.aspx?articleid=2490526
  6. Mangione CM et al. Screening for depression and suicide risk in children and adolescents: US Preventive Services Task Force recommendation statement. JAMA 2022 Oct 11; [e-pub]. PMID: 36219440 https://jamanetwork.com/journals/jama/fullarticle/2797145 - Viswanathan M et al. Screening for depression and suicide risk in children and adolescents: Updated evidence report and systematic review for the US Preventive Services Task Force. JAMA 2022 Oct 11; [e-pub]. PMID: 36219399 https://jamanetwork.com/journals/jama/fullarticle/2797146
  7. US Preventive Services Task Force Screening for Depression and Suicide Risk in Adults; US Preventive Services Task Force Recommendation Statement. JAMA. 2023;329(23):2057-2067 PMID: 37338872 https://jamanetwork.com/journals/jama/fullarticle/2806144
  8. Lowe B, Scherer M, Braunschneider LE, et al. Clinical effectiveness of patient-targeted feedback following depression screening in general practice (GET.FEEDBACK.GP): An investigator-initiated, prospective, multicentre, three-arm, observer-blinded, randomised controlled trial in Germany. Lancet Psychiatry 2024 Apr; 11:262 PMID: 38432236 Free article https://www.thelancet.com/journals/lanpsy/article/PIIS2215-0366(24)00035-X/fulltext
  9. Califf RM, Wong C, Doraiswamy PM Importance of Social Determinants in Screening for Depression. J Gen Intern Med. 2022 Aug;37(11):2736-2743. PMID: 34405346 PMCID: PMC9411454 Free PMC article.