Screen All Adults for Depression, Say USPSTF, AAFP

Evidence Shows Screening in Primary Care Setting Is Beneficial

January 27, 2016 10:55 am News Staff

On Jan. 26, the U.S. Preventive Services Task Force (USPSTF) released its final recommendation statement(www.uspreventiveservicestaskforce.org) on screening adults for depression in a primary care setting, including pregnant and postpartum women. The task force said this screening should be implemented with adequate systems in place to ensure accurate diagnosis, effective treatment and appropriate followup.

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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."

"Depression is a serious condition that is common among patients seen in primary care," said USPSTF member Michael Pignone, M.D., M.P.H., in a news release. "The Task Force recommends that primary care clinicians screen adult patients for depression."

The task force found that patients diagnosed with depression through clinical screening who went on to be treated with antidepressant medication, psychotherapy or both showed improvement in depression symptoms.

The AAFP mirrored the USPSTF's guidance in its own recommendations for adults.

It also should be noted that the recommendation statement pertains only to individuals 18 and older. The USPSTF has a separate recommendation statement that addresses children and adolescents,(www.uspreventiveservicestaskforce.org) which is in the process of being updated.

Story highlights
  • On Jan. 26, the U.S. Preventive Services Task Force (USPSTF) released its final statement recommending that all adults, including pregnant and postpartum women, be screened for depression in the primary care setting.
  • The task force found that patients diagnosed with depression through clinical screening who went on to be treated with antidepressant medication, psychotherapy or both showed improvement in depression symptoms.
  • The AAFP mirrored the USPSTF's guidance in its own recommendation for adults.

Host of Clinical Factors Considered

USPSTF members considered a wide range of clinical issues in formulating the final recommendation 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-age 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 USPSTF found that the evidence(www.uspreventiveservicestaskforce.org) supporting the benefits of screening was convincing, 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.

The final 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 appropriate intervals in various patient populations is needed.

Comments Drive Changes to Draft Recommendation

In late July, the USPSTF posted a draft version of the recommendation statement for public comment on its website. In its final statement, the task force noted that a number of commenters requested a more detailed definition of what constitutes an "adequate system" for screening. Accordingly, the USPSTF revised the Implementation section of its statement to clarify that a range of staff types, organizational arrangements and settings can be used to support the goals of depression screening.

The task force also provided a link(nrepp.samhsa.gov) to the Substance Abuse and Mental Health Services Administration registry of evidence-based mental health interventions as a resource for clinicians looking for models of how to implement screening.

In addition, there were several requests to clarify the potential harms of selective serotonin reuptake inhibitors; in response, the USPSTF added information about these antidepressant medications to the Discussion section.

Finally, many concerns were expressed about barriers to effectively implementing screening within adequate systems of care, which the task force agreed indicated a need for more research.

Related AAFP News Coverage
USPSTF Draft Statement Recommends Screening Teens for Depression
Evidence Is Insufficient to Recommend Screening for Children

(9/14/2015)


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