BMJ: US task force recommends screening for depression

[janet paterson <janet313@xxxxxxxxxxx>]

US task force recommends screening for depression

The US Preventive Services Task Force, an independent panel of healthcare
experts that advises the federal government on health care, is urging that
doctors routinely screen all adult patients for depression.

This is an upgrade of its 1996 recommendations, which found insufficient
evidence to support or rule out routine screening. The panel still finds
insufficient evidence to recommend for or against routine screening for
depression in children and adolescents, despite a prevalence of the illness
of up to 2% in children and 4.5% in adolescents. Clinicians should,
however, continue to be vigilant for signs of depression in children and
adolescents, the task force says.

The task force published the evidence for its recommendations on its
website and in the Annals of Internal Medicine (2002;136:765-76)[Medline].

It found that depression is often overlooked and undertreated and
contributes significantly to the uptake and costs of health care. Over 19
million adults in the United States experience depression in any given year.

Despite the prevalence of depression, studies indicate that primary care
providers miss 30-50% of cases.

Given these statistics, the expert panel set out to determine whether
systematic, routine screening of depression in adults is warranted and
whether treatment in a primary care setting is effective in improving
outcomes.

They also sought to determine whether integrated screening, follow up, and
management systems for depression would be more effective than usual care
in identifying and treating patients with depression. The task force based
its recommendations on a review of literature in the Medline and
Cochrane databases.

The Medline search included data from 1966 to 2001. Fourteen randomised
trials that examined the effect of screening on the identification and
treatment of the disease and healthcare outcomes were selected for review.

The studies were conducted in a primary care setting. Seven of the studies
showed that, compared with usual care, routine screening for depression
increased recognition of the disease by a factor of 2 to 3. All three
studies that looked at integrated screening and treatment found that it was
superior to usual care.

Screening methods differed in the studies reviewed and involved a variety
of questions. The panel found that asking just two targeted questions was
as powerful as other tests. The questions were: "Over the past two weeks,
have you felt down, depressed, or hopeless?" and "Over the past two weeks,
have you felt little interest or pleasure in doing things?" If the patient
replied yes to either
question, more investigation was warranted.

Dr André Tylee, a member of the steering committee of the UK's Defeat
Depression campaign, said that he did not think the guidelines were
transferable to the United Kingdom because of the differences in healthcare
systems.

Footnotes

The recommendations can be accessed at www.ahcpr.gov/clinic/uspstfix.htm

Deborah Josefson, Nebraska
BMJ 2002;324:1293 ( 1 June )


janet paterson: an akinetic rigid subtype, albeit primarily perky, parky
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