Primary Care Providers Should Screen For Depression: US Task Force
This week the U.S. Preventive Services Task Force posted a draft recommendation statement and draft evidence review on screening for depression in adults. Both are available for review and public comment from July 28 through August 24, 2015. In this proposal, the Task Force broadens its 2009 recommendation that adults should be screened in doctors’ offices if staff-assisted depression care is available.
The USPSTF recommends screening in all adults regardless of risk factors. There are a number of factors that are associated with an increased risk of depression. “Among general adult populations, prevalence rates vary by sex, age, race/ethnicity, education, marital status, geographic location, and employment. Women, young and middle-aged adults, and nonwhite individuals have higher rates of depression than their counterparts, as do persons who are undereducated, previously married, and unemployed. Other groups at increased risk of developing depression include persons with chronic illnesses (e.g., cancer or cardiovascular disease), other mental health disorders (including substance misuse), and a family history of psychiatric disorders.”
Risk factors for depression during pregnancy and postpartum should be reviewed and include “prenatal depression, poor self-esteem, childcare stress, prenatal anxiety, life stress, decreased social support, single/unpartnered relationship status, history of depression, difficult infant temperament, maternity “blues,” lower socioeconomic status, and unintended pregnancy.” Older adults also can present a number of risk factors for depression including “disability and poor health status related to medical illness–complicated grief, chronic sleep disturbance, loneliness, and a personal history of depression. However, the presence or absence of risk factors alone cannot distinguish patients with depression from patients without depression.”
The Task Force recommend measurement-based screening tools such as
the “Patient Health Questionnaire (PHQ), Hospital Anxiety and Depression Scales in adults, the Geriatric Depression Scale in older adults, and the Edinburgh Postnatal Depression Scale (EPDS) in postpartum and pregnant women. “All positive screening tests should trigger additional assessment that considers severity of depression and comorbid psychological problems (e.g., anxiety, panic attacks, or substance abuse), alternate diagnoses, and medical conditions.”
Treatments for depression include antidepressant medications, psychotherapy or both, according to the recommendation.
U.S. Preventive Services Task Force on Depression in Adults in Primary Care