Screening Toolboxes Remain Inadequate

In his study, Dr. Rhee and colleagues urge healthcare providers to follow the task force recommendations in actively screening older adults for depression, but the flaws of available screening tools should not be overlooked.

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“As shown in other literature reviews, depression screening tools are not perfect,” Dr Rhee told Psychiatry Advisor. “Depending on which survey questionnaires are performed, detection and treatment rates of depression and other mental health conditions vary.”

Although this problem is not limited to depression, the high overall prevalence of depression, with such substantial societal and cost burdens, means developing the right tools would have a sizable impact.

“Clinicians should be better trained about the importance and roles of depression screening to improve patient care,” Dr. Rhee told Psychiatry Advisor. “However, better screening tools should be developed to reduce high false-positive rates of depression screening.”

The problem of imprecise screening tools extends beyond this population as well, all the way to the other end of the age spectrum. A poster at Pediatric Academic Societies (PAS) 2017 Annual Meeting in May, for example, compared 2 depression screening tools in adolescents and found significant differences in prevalence. The American Academy of Pediatrics recommends annual depression screening for ages 11 to 21 years and estimates the prevalence of adolescent depression at about 20%, although neither tool in this study identified prevalence that high.

Researchers at Einstein Medical Center, led by Sabaa Alvi, MD, compared the HEADSSS (Home, Education, Activities, Drugs, Sex, Suicide/Depression, Safety) with the PHQ9A, a 9-question screen that focuses more specifically on depression symptoms. In their population, from an urban, low-income, minority community, 379 adolescents were screened with HEADSSS and yielded a depression prevalence of 6%. PHQ9A was administered to 226 adolescents, resulting in 14% prevalence of depression.

However, comparisons between the 2 differed considerably by sex and age. Although the PHQ9A found a higher prevalence among females, the HEADSSS identified a prevalence among males that was approximately 3 times greater than that found with PHQ9A. Similarly, those aged 13 to 15 years had nearly 8 times as many positive screens with the PHQ9A than HEADSSS, but that difference had eroded somewhat by ages 16 to 18 years, and no difference between the 2 screens existed at all for ages 19 to 21 years.

Taken together, these studies in very different populations simultaneously make a solid case for the value of routine screening for depression, as well as the urgent need for more sensitive and specific tools to do so.