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Screening for Depression in Adults
- Michael Pignone, MD, MPH;
- Bradley Gaynes, MD, MPH;
- Kathleen Lohr, PhD;
- Jerry Rushton, MD, MPH; and
- Cynthia Mulrow, MD, MSc
- Research Triangle Institute–University of North Carolina Evidence-based Practice Center; Chapel Hill, NC 27514 (Pignone, Gaynes, Lohr) University of Michigan; Ann Arbor, MI 48109 (Rushton) University of Texas Health Science Center; San Antonio, TX 78284 (Mulrow)
The Editors welcome submissions for possible publication in the Letters section. Authors of letters should:
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•Type with double-spacing
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Letters commenting on an Annals article will be considered if they are received within 6 weeks of the time the article was published. Only some of the letters received can be published. Published letters are edited and may be shortened; tables and figures are included only selectively. Authors will be notified that the letter has been received. If the letter is selected for publication, the author will be notified about 3 weeks before the publication date. Unpublished letters cannot be returned.
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IN RESPONSE:
We agree with Coyne and colleagues that outcomes for depressed patients in primary care are better when screening is coupled with systematic efforts to improve initiation and continuation of effective therapy, as exemplified in the study by Wells and colleagues (1). The recommendation statement by the USPSTF (2) that accompanied our systematic review also explicitly noted that screening was more effective when coupled with systematic support. Rather than “distract[ing]” from efforts to promote greater access to such services, we believe our evidence review and the USPSTF recommendation will further encourage payers and health systems to make the changes necessary to provide high-quality care for patients with depression. Existing evidence suggests that such care includes systematic efforts to identify patients with depression (“screening” or “case finding”).
The question of whether screening without systematic support for treatment and follow-up produces any benefit has generated a great deal of controversy (3). Critics often cite the number of “negative” studies as evidence of lack of efficacy, but many of the screening trials were too small to exclude important benefits of screening. Meta-analysis of the trials identified in our review, excluding the trials by Wells and Katzelnick and their colleagues (1, 4), shows that screening without such support produces an absolute reduction of 6 percentage points (95% CI, 0 to 12 percentage points) in the proportion of patients depressed at 6 months (Figure). This effect is smaller than the effect seen in the overall meta-analysis, which found a reduction of 9 percentage points (CI, 4 to 14 percentage points). These findings are consistent with our conclusion that screening without systematic support is probably more effective than usual care but that screening with systematic support is better than screening without it.
Michael Pignone, MD, MPH
Bradley Gaynes, MD, MPH
Kathleen Lohr, PhD
Research Triangle Institute–University of North Carolina Evidence-based Practice Center; Chapel Hill, NC 27514
Cynthia Mulrow, MD, MSc
University of Texas Health Science Center; San Antonio, TX 78284
The Editors welcome submissions for possible publication in the Letters section. Authors of letters should:
•Include no more than 300 words of text, three authors, and five references
•Type with double-spacing
•Send three copies of the letter, an authors' form signed by all authors, and a cover letter describing any conflicts of interest related to the contents of the letter.
Letters commenting on an Annals article will be considered if they are received within 6 weeks of the time the article was published. Only some of the letters received can be published. Published letters are edited and may be shortened; tables and figures are included only selectively. Authors will be notified that the letter has been received. If the letter is selected for publication, the author will be notified about 3 weeks before the publication date. Unpublished letters cannot be returned.
Annals welcomes electronically submitted letters.
- Copyright ©2004 by the American College of Physicians
