According to data from(www.cdc.gov) the National Health and Nutrition Examination Survey, 2007-2010, one out of about every dozen people age 12 or older has experienced symptoms of depression in the past two weeks. Among females, the prevalence is one in 10.
Add to that the fact that the disorder accounts for more than 8 million ambulatory care visits(www.cdc.gov) each year and costs the nation upwards of $210 billion(www.psychiatrist.com) annually (i.e., direct medical, suicide-related mortality and indirect workplace costs), and it's clear that detecting depression early and securing treatment are critical public health goals.
Enter the U.S. Preventive Services Task Force (USPSTF), which has just released a draft recommendation statement(www.uspreventiveservicestaskforce.org) on screening adults for depression in the primary care setting. Specifically, the task force "recommends screening for depression in the general population, including pregnant and postpartum women."
"Screening should be implemented with adequate systems in place to ensure accurate diagnosis, effective treatment and appropriate follow-up," the draft statement adds. These systems are further defined as part of the full recommendation statement.
This is a grade B(www.uspreventiveservicestaskforce.org) recommendation, meaning the USPSTF determined that "there is high certainty that the net benefit is moderate or there is moderate certainty that the net benefit is moderate to substantial."
- The U.S. Preventive Services Task Force has just released a draft statement that recommends screening all adults for depression in the primary care setting.
- The recommendation pertains only to asymptomatic individuals 19 and older, including pregnant and postpartum women.
- Screening should be implemented with adequate systems in place to ensure accurate diagnosis, effective treatment and appropriate follow-up.
It should be noted that the draft statement pertains only to individuals 19 and older. The USPSTF has a separate recommendation statement that addresses children and teens,(www.uspreventiveservicestaskforce.org) which itself is in the process of being updated.
Host of Clinical Factors Considered
USPSTF members considered a wide range of clinical issues in formulating the draft statement. Although the statement is not risk-based, the task force said it recognizes that certain subpopulations of patients are at increased risk for depression. In particular, women, younger and middle-aged adults, and nonwhite individuals have relatively higher rates of depression, as do people who are undereducated, previously married or unemployed.
Certain comorbid conditions also can predispose patients to depression, such as chronic illness, other mental health issues and a family history of psychiatric problems. Pregnant women may be at increased risk for depression based on certain lifestyle factors and pregnancy-related issues, and older adults who struggle with disability or poor health status related to medical illness may also be at particular risk.
The draft recommendation lists a number of commonly used screening instruments, such as the Patient Health Questionnaire, the Hospital Anxiety and Depression Scale, the Geriatric Depression Scale for older adults and the Edinburgh Postnatal Depression Scale for pregnant and postpartum women. Task force members did not identify an optimal screening interval, saying more research on various patient populations is needed.
Overall, research regarding the benefits of screening was convincing, said the USPSTF, comprising numerous good- and fair-quality studies among each of the various subpopulations considered. In addition, adequate evidence showed that the magnitude of potential harms of screening overall was small to none.
New Language Reflects Changing Times
Two elements of the current draft statement set it apart from the task force's previous recommendation on depression screening in adults, which the Academy adopted. One is the specific inclusion of pregnant and postpartum women, subpopulations that were not reviewed for the 2009 USPSTF recommendation.
The second factor concerns the reference to "adequate systems in place" in the current draft. The task force's earlier statement made its positive recommendation conditional on the presence of such support systems, to wit: "The AAFP recommends screening adults for depression when staff-assisted depression care supports are in place to assure accurate diagnosis, effective treatment, and follow-up."
The current draft recommendation, on the other hand, recognizes that such support is "much more widely available and accepted as part of mental health care" and has omitted the previous language as no longer representative of the clinical practice environment.
The task force will accept comments on the draft recommendation(www.uspreventiveservicestaskforce.org) and its accompanying draft evidence review(www.uspreventiveservicestaskforce.org) through Aug. 24.
The AAFP is reviewing the USPSTF's draft recommendation and will update its own recommendation after the task force publishes its final recommendation statement.