Depression is common the estimated lifetime prevalence is 15%. Most patients with depressive disorders are treated by primary care physicians. Approximately 43% of such primary care patients report some degree of suicidal ideation within the previous week. So treating these patients is no sinecure. Moreover, diagnosing depressive disorder in primary care is not easy.
Is it useful to do screening for depression in primary care?
A review was conducted for the U.S. Preventive Services Task Force about the benefits and harms of screening adult patients for depression. The articles were reviewed by two investigators against in and exclusion criteria, the articles were rated for quality, abstracted data were included in evidence tables. The draft of the review was reviewed by 6 experts and revised on the basis of their comment. Impressive work.
The authors discuss the used articles very thoroughly. Overall, depression screening without further diagnosing and staff-assisted depression care support is unlikely to improve depression outcomes. Staff-assisted depression care supports refers to clinical staff that assist the primary care clinician by providing some direct depression care, such as care support or coordination, case management, or mental health treatment. The benefits of these interventions is enhanced treatment adherence through closer monitoring of treatment tolerability and response, treatment adjustments, and psychosocial support.
- No evidence was found that screening might harm depressed patients.
- They also found that pharmacological and psychotherapeutic help is effective in older adults.
- Meta-analyses suggest no increase in suicide with antidepressants
- Most patients tolerated antidepressants (88% to 95%)
- Adverse side effects and discontinuation were higher in older adults.
- Large population based observational studies suggest that upper gastrointestinal bleeding is a concern for older adults, particularly when antidepressants are combined with nonsteroidal antiinflammatory drugs (NSAIDs).
- Compared to placebo there was no evidence from 7 meta-analyses for increased odds of completed suicide with second generation antidepressants.
- No significant difference in suicidal behavior or suicidal ideation between placebo and antidepressants. Only younger adults (18-29) seem to have increased risk for suicidal behavior especially early in the course of treatment.
- Rates of early discontinuation ranged from 16%-29%.
How to screen for depression?
Screening tests for depression include the Zung Self Depression Scale, Beck Depression Inventory, General Health Questionnaire, Center for Epidemiologic Study Depression Scale, SelfCARE (D), and Geriatric Depression Scale. Most of these tests have relatively good sensitivity (80% – 90%), but only fair specificity (70% – 85%); are easy to use; and can be administered in less than 5 minutes
Screening for Depression in Adult Patients in Primary Care Settings:A Systematic Evidence Review
By Elizabeth A. O’Connor, PhD; Evelyn P. Whitlock, MD, MPH; Tracy L. Beil, MS; and Bradley N. Gaynes, MD, MPH
Address correspondence to: Elizabeth O’Connor, PhD, Kaiser Permanente Center for Health Research, 3800 North Interstate Avenue, Portland, OR 97227.
Ann Intern Med 2009;151:793-803