Abstract
BackgroundSystematic screening for depression in high-risk patients is recommended but remains controversial. The aim of this study was to assess the effectiveness of such screening in everyday clinical practice on depression recognition.MethodsA pragmatic, cluster randomized, controlled study that randomized primary care physicians (PCPs) in Spain either to an intervention or control group. The intervention group (35-PCPs) received training in depression screening and used depression screening routinely for at least 6 months. The control group (34-PCPs) managed depression in their usual manner. Adherence to (1–6; never-very frequently), feasibility (1–4; unfeasible-very feasible), and acceptance (1–5; very poor-very good) of the screening were evaluated. Underrecognition (primary outcome) and undertreatment rates of major depressive disorder (MDD) in the two groups were compared 6 months after randomization in a random sample of 3737 patients assigned to these PCPs using logistic regression adjusting for the clustering effect.ResultsNo significant differences were found for recognition rates (58.0% vs. 48.1% intervention vs. control; OR [95%CI] 1.40 [0.73-2.68], p = 0.309). The undertreatment rate did not differ significantly either (p = 0.390). The mean adherence to depression screening was 4.4 ± 1.0 (‘occasionally’), the mean feasibility was 3.1 ± 0.5 (‘moderately feasible’), and the mean acceptance was 4.2 ± 0.6 (‘good’).ConclusionsThis research was not able to show effectiveness of the systematic screening for MDD in high-risk patients on depression recognition in primary care. The poor adherence to screening implementation could partially explain the results. These reflect the difficulties of putting into practice the clinical guidelines usually based on interventional research.Trial registrationClinicaltrials.gov NCT01662817
Highlights
Systematic screening for depression in high-risk patients is recommended but remains controversial
The present paper presents the results of a pragmatic research that tested the hypothesis whether implementing the guidelines on screening for depression in high-risk patients in everyday clinical practice reduces the underrecognition of Major depressive disorder (MDD) in primary health care (PC)
Summary of main findings Contrary to our hypothesis, we did not find significant differences for the underrecognition rate of MDD between patients treated by primary care physicians (PCPs) who followed guidelines for screening and those treated by PCPs who did not
Summary
Systematic screening for depression in high-risk patients is recommended but remains controversial. The guidelines on systematic screening for depression recommend, as one possible screening strategy, asking the patient two questions about their mood and anhedonia, followed by a diagnostic interview if screening is positive [5,6,7,8] It has been proposed by the US preventive Services Task Force, that depression screening in primary care should be aimed at patients at high risk of depression, such as patients with a history of depression, psychological comorbidities, unexplained somatic symptoms, or disability due to physical illnesses [13]. Two further studies have been published assessing the extent of implementation of screening in the PC setting [17,18], showing very low [17] and very high [18] use of depression screening
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