Screening for Depression and Suicide Risk in Adults

A 26-year-old new mother reports increased irritability, fatigue, and weight loss. She notes that the symptoms started worsening 2 months ago when she went back to work. She is unable to focus at work and has lost interest in her job and previous leisure activities since giving birth. She is breastfeeding her 8-month-old daughter.

1. According to the US Preventive Services Task Force (USPSTF) recommendation on screening for depression and suicide risk in adults, what is the most appropriate next step?

• A. Determine whether she has a history of depression.
• B. Determine whether she has a family history of depression or other mood disorders.
• C. Screen for major depressive disorder.
• D. Recommend that the patient quit her job and stay home.
• E. Screen for thyroid disorders and advise the patient that the mood issues are likely “baby blues.”

2. The USPSTF recommendation on screening for depression and suicide risk in adults defines perinatal depression as which of the following?

• A. Depressive episodes that occur during pregnancy.
• B. Only depressive episodes that start within 6 weeks after delivery.
• C. Depressive episodes that occur during the postpartum period (the first 12 months after delivery).
• D. Only depressive episodes that start prior to delivery.

3. The patient says that she has experienced a few episodes in which she considered harming herself. According to the USPSTF recommendation on screening for depression and suicide risk in adults, which one of the following statements is correct?

• A. She should not be screened, because she was already evaluated for major depressive disorder.
• B. She should be hospitalized immediately.
• C. The USPSTF recommendation applies to screening asymptomatic adults and does not apply to a patient with major depression and thoughts of self-harm.
• D. The evidence is insufficient regarding the benefit and harms of screening for suicide risk in adults, including pregnant and postpartum women.
• E. The highest suicide rates of women occur in this patient's age group (25 to 44 years of age).

1. The correct answer is C. The USPSTF recommends screening for major depressive disorder in adults, including pregnant and postpartum women and adults older than 64 years. This recommendation also applies to patients without recognized signs or symptoms of depression (B recommendation).¹ Compared to men, women are twice as likely to develop depression.²
2. The correct answers are A and C. The USPSTF defines perinatal depression as depressive episodes that occur during pregnancy and the postpartum period (the first 12 months after delivery).¹
3. The correct answer is C. The USPSTF concluded that the evidence is insufficient regarding the benefits and harms of screening for suicide risk in adults in the general population, including pregnant and postpartum people and older adults.¹

In the absence of evidence regarding screening for suicide risk, health care professionals should use their judgment, based on individual patient circumstances, when deciding whether to screen. Any individual who expresses concerns or reports symptoms about these conditions should be connected to appropriate care. The highest suicide rates occur between the 45 and 54 years of age (in women) and after 65 years of age (in men).²