Intended for healthcare professionals

Practice Uncertainties

Does depression screening in primary care improve mental health outcomes?

BMJ 2021; 374 doi: https://doi.org/10.1136/bmj.n1661 (Published 19 July 2021) Cite this as: BMJ 2021;374:n1661
  1. Brett D Thombs, professor1,
  2. Sarah Markham, visiting researcher2,
  3. Danielle B Rice, doctoral student1,
  4. Roy C Ziegelstein, professor3
  1. 1Lady Davis Institute for Medical Research, Jewish General Hospital and McGill University, Montréal, Québec, Canada
  2. 2King’s College London, UK
  3. 3Johns Hopkins University School of Medicine, Baltimore, MD, USA
  1. Correspondence to B D Thombs brett.thombs{at}mcgill.ca

What you need to know

  • International guidelines and practice differ regarding screening for depression; it is not currently recommended in the UK

  • Little high quality evidence is available from primary care settings on the benefits of depression screening in improving mental health outcomes for patients

  • Instead of routinely screening all patients in primary care, engage patients in discussions about their overall wellbeing, including mental health, and be alert to clinical cues that could suggest depression

Depression is usually identified when patients report symptoms or when clinicians recognise them through routine assessment of patient wellbeing. Screening can potentially increase rates of depression recognition. Depression screening involves administering a symptom questionnaire to all patients not known or not suspected of having depression. It is intended to identify symptomatic people who may not otherwise be recognised or seek treatment.12 A cut-off is used to classify positive and negative results, with further assessment of those with positive results, and, as appropriate, management. The Patient Health Questionnaire-9 (PHQ-9) is among the most used depression screening tools in primary care.3

In the UK, the National Institute for Health and Care Excellence (NICE) encourages general practitioners to be alert to possible depression, but not to screen routinely.4 The National Screening Committee recommends against screening.5 Depression screening in general practice was financially incentivised by the UK Quality and Outcomes Framework from 2006 to 2013 but was subsequently removed owing to disappointing results; almost 1000 patients had to be screened for each new depression diagnosis and almost 700 for each new antidepressant prescription.6 In North America, the Canadian Task Force on Preventive Health Care (CTFPHC) recommends against screening,7 whereas the US Preventive Services Task Force (USPSTF) recommends screening all primary care patients “with adequate systems in place to ensure accurate diagnosis, effective treatment, and appropriate follow-up.”8 …

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