Screening for Depression: Recommendations from the U.S. Preventive Services Task Force

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The summary below is from the full reports titled "Screening for Depression: Recommendations and Rationale" and "Screening for Depression in Adults: A Summary of the Evidence for the U.S. Preventive Services Task Force." They are in the 21 May 2002 issue of Annals of Internal Medicine (volume 136, pages 760-764 and pages 765-776). The first report was written by the U.S. Preventive Services Task Force; the second report was written by MP Pignone, BN Gaynes, JL Rushton, CM Burchell, CT Orleans, CD Mulrow, and KN Lohr.

What is the U.S. Preventive Services Task Force?

The U.S. Preventive Services Task Force (USPSTF) is a group of health experts that reviews published research and makes recommendations about preventive health care.

What is the problem and what is known about it so far?

Depression causes sadness that interferes with daily life. Depression is a medical condition, not a normal reaction to a life situation such as the death of a loved one or the loss of a job. About 1 out of every 5 people suffers depression at some time in his or her life, and depression is common among patients who see primary care providers. Common depression symptoms are lack of energy and loss of interest in things previously enjoyed. Sometimes depression goes away on its own, but many depressed people need treatment with counseling or medication to speed recovery. Often, people with depression do not realize that their feelings are due to a medical condition and do not seek medical care for depression.

Some experts think that doctors should screen patients for depression. Screening involves looking for a disease in people who do not report symptoms. Patients found through screening can begin treatment. Screening works best when doctors' offices have systems in place to support accurate diagnosis, prescription of effective treatment, and careful follow-up of depressed patients. Benefits from screening are unlikely to be realized unless such systems are functioning well.

We know that depression is common and that asking patients about sad feelings can identify patients with depression. However, it has not been clear whether screening for depression by routinely asking patients about its symptoms improves patient outcomes.

How did the USPSTF develop these recommendations?

The USPSTF reviewed published research to evaluate the benefits and harms of screening for depression.

What did the USPSTF find?

Good evidence suggests that health care providers who routinely ask patients about sad feelings will identify more adults with depression. There is no evidence that one method of screening for depression works better than another. It does appear that two questions—1] Over the past 2 weeks, have you ever felt down, depressed, or hopeless? 2) Over the past 2 weeks, have you felt little interest or pleasure in doing things?—can identify patients with depression as well as longer sets of questions can. Good evidence shows that treating depression with counseling, medications, or both improves patient outcomes. Research on how frequently depression screening should occur is lacking. There is limited evidence about how well depression screening works in children and adolescents.

What does the USPSTF suggest that patients do?

Adults who visit doctors for routine care may find that their doctors ask them about depression symptoms. If their answers to these questions suggest that they might have depression, the doctors should arrange a more thorough examination. Patients who are troubled by unexplained sadness, lack of interest in life, constant blue mood, and low energy should tell their doctors about these symptoms.

What are the cautions related to these recommendations?

The USPSTF found limited evidence on how well screening for depression works when clinicians don't have tools to help improve diagnosis and treatment and allow appropriate follow-up. There is little information about which screening questions work best and how often they should be asked. The recommendations may become more specific as more studies are done.