Analysis And Comment Health policy

Should we screen for depression?

BMJ 2006; 332 doi: http://dx.doi.org/10.1136/bmj.332.7548.1027 (Published 27 April 2006) Cite this as: BMJ 2006;332:1027
  1. Simon Gilbody, senior lecturer in mental health services research1 (sg519@york.ac.uk),
  2. Trevor Sheldon, pro vice chancellor1,
  3. Simon Wessely, professor of epidemiological and liaison psychiatry2
  1. 1 Department of Health Sciences, University of York, York YO10 5DD
  2. 2 Academic Department of Psychological Medicine, Guy's, King's, and St Thomas's School of Medicine, Institute of Psychiatry, London SE5 8AF
  1. Correspondence to: S Gilbody
  • Accepted 8 March 2006

The quality and outcomes framework will soon reward primary care doctors who screen for depression in England and Wales. This article scrutinises the rationale and evidence to support such screening

“All screening programmes do harm; some do good as well.”

Depression is common in primary care and hospital settings, but it is often not recognised by healthcare professionals.2 3 This has led to calls for screening programmes to aid detection and management.4 We use the criteria of the UK National Screening Committee to judge whether screening would do more good than harm.5 We drew on our experience in preparing a Cochrane review of the evidence for screening for depression.6

Depression screening as national health policy

In the United States screening for common mental health problems is thought to be effective and is a cornerstone of the agenda to improve mental health; population level screening programmes are supported by the drug industry.7 w1 w2 Similar national programmes have been advocated in Australia.w3 In England and Wales, screening has been supported more cautiously by the National Institute for Health and Clinical Excellence (NICE), which recommends that it should be offered to people at high risk of depression.w4 Screening may become health policy in England and Wales, since primary care doctors will be rewarded for “enhanced services for depression” within the quality and outcomes framework (QOF), which will include a screening programme.w5

In the past screening programmes have been implemented without due consideration of their effectiveness, their ethical and clinical implications, and their impact on finite healthcare resources.8 w6 Consequently, the National Screening Committee has been established in the United Kingdom; this committee works to specific criteria to help ensure that screening “does more good than harm.”5 These criteria pertain to the condition, the test, the treatment, and the …

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