Abstract
Thombs and colleagues have shown that screening consecutive attendees in primary care settings in high income countries for depression is not worthwhile. However, it is dangerous to generalize from high income countries such as the USA to the rest of the world. The positive predictive value of any screening test for depression is affected by the prevalence of the disorder in the population being considered. Populations with an increased prevalence of depression, such as those with chronic physical disorders, or with a history of depression or other mental health problems may benefit from screening, even in high income countries. Populations in low and middle income countries (LMIC) may also benefit from screening if they are experiencing severe social adversity, including poverty. Two examples are given, in which screening with a brief screening questionnaire was followed by collaborative stepped care, to the considerable benefit of the patients in LMIC.Please see related article: http://www.biomedcentral.com/1741-7015/12/13.
Highlights
Main text Thombs and colleagues [1] have brought the argument about screening consecutive attendees for depression up to date, but there is really nothing new in their general conclusion that in high income countries there are no positive gains in the use of screening tests for depression
The guideline was re-issued in 1999 [7] with substantially the same advice, advising clinicians to be alert to possible depression and consider asking people who may have depression the two screening questions that are used to define depression in both the International Classification of Disease [8] and the Diagnostic and Statistical Manual (DSM) system of the American Psychiatric Association [9]
The positive predictive value of a screening test The original National Institute for Health and Clinical Excellence (NICE) guideline for depression [6] concluded that high prevalence populations could be screened with much better results
Summary
Thombs and colleagues [1] have brought the argument about screening consecutive attendees for depression up to date, but there is really nothing new in their general conclusion that in high income countries there are no positive gains in the use of screening tests for depression. The positive predictive value of a screening test The original National Institute for Health and Clinical Excellence (NICE) guideline for depression [6] concluded that high prevalence populations could be screened with much better results.
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