Practice Uncertainties Page

Does depression screening improve depression outcomes in primary care?

BMJ 2014; 348 doi: https://doi.org/10.1136/bmj.g1253 (Published 04 February 2014) Cite this as: BMJ 2014;348:g1253
  1. Brett D Thombs, associate professor1,
  2. Roy C Ziegelstein, professor2
  1. 1Lady Davis Institute for Medical Research, Jewish General Hospital and McGill University, Montréal, Québec, Canada, H3T 1E4
  2. 2Johns Hopkins University School of Medicine, Baltimore, Maryland, USA, 21224
  1. Correspondence to: B D Thombs brett.thombs{at}mcgill.ca
  • Accepted 15 November 2013

Major depression is present in 5-10% of patients in primary care,1 2 including 10-20% of patients with chronic medical conditions.3 Based on the prevalence and burden of depression, the availability of screening tools, and access to potentially effective treatments, routine depression screening has been proposed as a way to improve depression care. Depression screening involves the use of self administered questionnaires or small sets of questions to identify patients who may have depression but who are not already diagnosed or being treated for depression.4

Clinical practice guidelines do not agree on whether health professionals should screen for depression in primary care. The US Preventive Services Task Force (USPSTF) recommends screening for depression when enhanced, staff assisted, depression care programmes are in place to ensure accurate diagnosis and effective treatment and follow-up.1 The Canadian Task Force on Preventive Health Care previously endorsed a similar recommendation, but in 2013 recommended against depression screening in primary care, citing a lack of evidence of benefit from randomised controlled trials and concern that a high proportion of positive screens would be false positives.5

In the UK, the National Screening Committee has determined that there is no evidence of benefit from depression screening to justify costs and potential harms and has recommended against it.6 A 2010 guideline from the National Institute for Health and Care Excellence (NICE) did not recommend routine depression screening, but suggested that clinicians be alert to possible depression, particularly among patients with a history of depression or with a chronic medical condition. NICE recommended that healthcare providers consider asking people suspected of having depression two screening questions related to depressed mood and loss of interest, and consider formal mental health assessment for people responding “yes” to either.2 In contrast to these recommendations, between 2006 and …

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