USPSTF Presents Updated Guidelines For Depression Screening In Adults

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In an update of their 2009 guidelines, the US Preventive Services Task Force has provided updated recommendations for screening for depression in adults.
In an update of their 2009 guidelines, the US Preventive Services Task Force has provided updated recommendations for screening for depression in adults.

After completing a medical literature review, the US Preventive Services Task Force has concluded that all members of the general adult population should be screened for depression, according to a recommendation statement released in JAMA.

“Depression is among the leading causes of disability in persons 15 years and older,” wrote author Albert L Siu, MD, MSPH, professor of General Internal Medicine at Mount Sinai Hospital in New York City.

The recommendation, which applies to adults 18 years and older and includes pregnant and postpartum women, emphasizes that screeners should have adequate systems in place to ensure an accurate diagnosis, effective treatment, and appropriate follow-up. The USPSTF found evidence that potential harms of depression screening and treatment with cognitive behavioral therapy (CBT) in postpartum and pregnant women were “small to none,” while second-generation antidepressants–primarily selective serotonin reuptake inhibitors (SSRIs)– may be associated with some harms, including an increase in suicidal behaviors in adults between ages 18 and 29.

While the optimal depression screening timing and interval remains unknown, the USPSTF suggests screening all adults, regardless of risk factors, who have not been screened previously, and using clinical judgment to determine on a case-by-case basis if additional screening is necessary. Clinicians considering treatment may recommend antidepressants, specific psychotherapy approaches, or a combination of both. Clinicians treating pregnant or breastfeeding women should keep in mind the potential harms to the fetus or newborn child that may result from the use of certain SSRIs.

“Major depressive disorder is a common and significant health care problem,” wrote Dr Siu. “The USPSTF concludes with at least moderate certainty that there is a moderate net benefit to screening for depression in adults 18 years and older.”

Population

Adults aged 18 and older

Risk Assessment

The following groups of people have higher rates of depression: women, young adults, middle aged adults, and nonwhite persons.

Risk factors in older adults include: disability, poor health status related to medical illness, complicated grief, chronic sleep disturbance, loneliness, and history of depression.

Risk factors during pregnancy and postpartum include: poor self-esteem, child care stress, prenatal anxiety, life stress, decreased social support, single or unpartnered relationship status, history of depression, difficult infant temperament, previous postpartum depression, lower socioeconomic status, and unintended pregnancy.

Screening Tests

Commonly used depression screening tests include the Patient Health Questionnaire and the Hospital Anxiety and Depression Scales in adults; the Geriatric Depression Scale in older adults; and the Edinburgh Postnatal Depression scale in pregnant and postpartum women. Positive screening results should lead to additional assessment that considers the following: severity of depression, comorbid psychological problems, alternate diagnoses, and medical conditions.

Screening Interval

The optimal timing and interval for depression screening is not known. A pragmatic approach may include screening all previously unscreened adults, and using clinical judgment when considering the necessity of potential additional screening.

Treatment and Interventions

Effective treatment of depression in adults typically includes antidepressants or specific psychotherapy approaches, either alone or in combination. Clinicians are encouraged to consider evidence-based counseling interventions when treating pregnant or breastfeeding women.

Balance of Benefits and Harms

The net benefit of depression screening in the general adult population is moderate.

Adapted from the USPSTF Recommendation Statement.

Reference

Siu AL. Screening for depression in adults US Preventative Services Task Force recommendation statement. JAMA. 2016;315(4):380-387. doi: 10.1001/jama.2015.18392

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