Screening for depression in general practice and related medical settings.

Abstract

To determine if screening in general practice and related medical settings improves management and clinical outcomes in people with depression. The Medline (1966-2002), EMBASE (1980-2002) and PsycINFO (1966-2002) databases were searched. These were supplemented by searching the Cochrane databases (to 2002); performing additional specific searches on Medline, EMBASE and PsycINFO; scrutinising reference lists of selected articles; and querying experts. Inclusion criteria were: review of prospective studies with a primary focus of depression screening in general practice settings; review of studies of healthy populations or people with known depression; publication in a peer-reviewed journal; and written in English. Eleven reviews that satisfied these criteria were assessed for quality using the Oxman and Guyatt Index. Four reviews met the criterion of a score of five or more. One author tabulated relevant material (including number and type of studies, outcomes/endpoints, measures of association/statistical results, and findings) from the four key reviews. A second author independently checked the accuracy of this extracted material. Brief self-report instruments have acceptable psychometric properties and are practical for use in general practice settings. Screening increases the recognition and diagnosis of depression and, when integrated with a commitment to provide coordinated and prompt follow-up of diagnosis and treatment, clinical outcomes are improved. Although controversial, the evidence is now in favour of the appropriate use of screening tools in primary care.