Screening For Depression In Adults Research Articles

Evaluating Different Strategies to Screen for Depression in Sickle Cell Disease

Introduction Sickle Cell Disease (SCD) is an inherited blood disorder affecting approximately 100,000 Americans, most from socially disadvantaged groups. Adults with SCD have a significant burden of depression, which can adversely affect their quality of life, the clinical course of their SCD, and mortality. National guidelines recommend screening for depression in adults annually. Also, adults with SCD may not report symptoms routinely in the clinic since they can be stigmatized. Therefore, screening for depression is critical in managing adults with SCD. A standard tool to screen for depression is the nine-item Patient Health Questionnaire (PHQ-9). This measure can be self-administered on paper or a tablet or administered by healthcare providers or staff in the clinic by asking them questions. There is a gap in our knowledge of the optimal strategy to screen for depression in SCD. Objective To close this knowledge gap, we tested the hypothesis that the strategy of a self-administered depression screening questionnaire PHQ-9 on a tablet during clinic would have more positive screenings for depression than the strategy of asking the PHQ-9 questions by nurses. Methods This study was part of a prospective cohort of adults with SCD in a patient-centered medical home with an integrated primary care provider at the Ohio State University Wexner Medical Center Comprehensive Sickle Cell Clinic. Adults with any type of SCD were recruited between January 1, 2021, and March 31, 2023. These participants were given tablets to self-administer the PHQ-9 and were also asked the PHQ-9 questions by the nursing staff. The total score determined positive screening and severity of depression. Scores ≥5, ≥10, ≥15, and ≥20 represent mild, moderate, moderately severe, and severe depression, respectively. We used a proportions test for differences among the proportion who screened positive for depression between the two strategies and a Welch's t-test of independence to determine differences in PHQ-9 scores. The Ohio State University IRB approved this study. Results A total of 50 adults with SCD, aged 18 to 67, were recruited after meeting the inclusion criteria. Of these 50 adults, 60% were female. The categorization of the severity of depression varied between the two strategies, with more participants in the self-administered group having higher categories of depression (Table 1). Only 24% of the nurse-administered scores screened positive for depression, while 48% of the self-administered scores positively screened for depression (p = 0.02). The mean PHQ-9 score was higher with self-administered PHQ-9 (mean: 5.60; standard deviation (SD): 5.72) compared to clinic-administered PHQ-9 by nurses (mean: 3.32; SD: 4.62, p = 0.03). Conclusions Our study is the first to demonstrate the importance of the strategy of screening for depression in adults with SCD. Lower levels of depression were reported when nurses screened for depression compared to when adults with SCD completed the questionnaire independently. The PHQ-9 is commonly used to screen for depression, but depending on the clinic, the administration of the questionnaire may differ, which may lead to suboptimal screening for depression. Identifying the optimal strategy for screening for depression is crucial in this population with a high burden of depression, as depression can ultimately affect their outcomes. This study was limited by being at a single center and the selection bias of only including those who presented in the SCD clinic. Future multi-center studies for optimal strategies to screen, diagnose, and manage depression among adults with SCD are needed.

Screening for depression among the general adult population and in women during pregnancy or the first-year postpartum: two systematic reviews to inform a guideline of the Canadian Task Force on Preventive Health Care

BackgroundDepression affects an individual’s physical health and mental well-being and, in pregnant and postpartum women, has specific adverse short- and long-term effects on maternal, child, and family health. The aim of these two systematic reviews is to identify evidence on the benefits and harms of screening for depression compared to no screening in the general adult and pregnant and postpartum populations in primary care or non-mental health clinic settings. These reviews will inform recommendations by the Canadian Task Force on Preventive Health Care.MethodsWe searched MEDLINE, Embase, PsycINFO, CINAHL, and the Cochrane Library using a randomized controlled trial filter, where applicable, October 4, 2018, and updated to May 11, 2020. We also searched for gray literature (e.g., websites of organizations of health professionals and patients). Study selection for depression screening trials was performed first on title and abstract, followed by full-text screening. Data extraction, assessment of the risk of bias using the Cochrane risk of bias tool, and application of Grading of Recommendations Assessment, Development and Evaluation were performed by one reviewer and validated by a second reviewer.ResultsA total of three trials were included. All three trials were included in the general adult review, while one of the three trials was included in the pregnant and postpartum review. We did not pool results due to substantial differences between studies and high risk of bias. In the general adult review, the first trial (n = 1001) evaluated whether screening for depression in adults with acute coronary syndrome compared to usual care improves health-related quality of life, depression symptoms, or harms of screening at 6, 12, and 18 months. There were little to no differences between the groups at 18 months for the outcomes. The second trial included adults (n = 1412) undergoing initial consultation for osteoarthritis, evaluated for depression and general health (mental and physical) after initial consultation and at 3, 6, and 12 months. The physical component score was statistically significantly lower (worse health) in the screened group at 6 months; however, this difference was not significant at 3 or at 12 months. There were no clinically important or statistically significant differences for other outcomes between groups at any time. The third trial (included in both reviews) reported on 462 postpartum women. At 6 months postpartum, fewer women in the screening group were identified as possibly depressed compared to the control group (RR 0.59, 95% confidence interval (CI) 0.39 to 0.89) and mean EPDS scores were also statistically significantly lower in the screened group (standardized mean difference 0.34 lower (95% CI 0.15 to 0.52 lower)). All other outcomes did not differ between groups at follow-up. There were serious concerns about the cut-offs used for the questionnaire used to screen, diagnostic confirmation, selective outcome reporting, and the reported magnitude of effects.DiscussionThere are limitations of the evidence included in the reviews. There was moderate certainty in the evidence from one trial that screening for depression in the general adult population in primary care or non-mental health clinic settings likely results in little to no difference on reported outcomes; however, the evidence was uncertain from the other two included trials. The evidence is very uncertain about the effect of screening for depression in pregnant or postpartum women in primary care or non-mental health clinic settings. Well-conducted and better-reported trials are needed that meet the screening trial criteria used in this review.Systematic review registrationBoth protocols have been registered in the International Prospective Registry of Systematic Reviews (PROSPERO) [adult: CRD42018099690; pregnancy and postpartum: CRD42018099689] and published (https://systematicreviewsjournal.biomedcentral.com/track/pdf/10.1186/s13643-018-0930-3).

Depression screening in adults by pharmacists in the community: a systematic review.

Improving the identification of depression in adults in primary care can produce clinical and economic benefits. Community Pharmacists may play a role in screening for depression. To systematically review and evaluate the evidence for the feasibility, impact and cost-effectiveness of community pharmacists screening adults for depression. An electronic literature search using the databases EMBASE, PubMed and CINAHL Complete from January 2000 to September 2019 was undertaken to identify studies involving community pharmacists screening for depression. Data relating to sample size, population demographics and medical conditions of adults screened were extracted. Details around the screening model, process-related outcomes, clinical outcomes and economic outcomes were also extracted. Ten studies using eight unique depression screening tools were identified. Ease of administration was the most common selection criterion (n=4) while no reason was given in four studies. Seven studies reported that through screening, pharmacists could identify adults with undiagnosed depression. Pharmacists referred adults screening positive for assessment in seven studies and followed up participants in two studies. No study assessed the impact of screening on depressive symptoms or the cost-effectiveness of pharmacists screening for depression. Community pharmacists are able to use depression screening tools to identify undiagnosed adults having symptoms of depression. However, there is little evidence around the impact of this screening on clinical and economic outcomes. Larger, well-designed studies that use a highly accurate, easily administered screening tool and include patient referral and follow-up and pharmacist training are warranted to provide evidence on the impact of community pharmacists screening adults for depression.

611 Screening Adults for Depression and Suicidality in an Outpatient Burn Center

Abstract Introduction In response to NIH recommendations and ABA verification standards, a protocol was initiated to screen adult burn patients in an outpatient verified burn center for depression and suicidality. It utilized the Patient Health Questionnaire (PHQ-9), a widely recognized depression screening tool. The protocol dictated patients scoring 10 or greater, or endorsing the suicide risk question would require further assessment. This project was part of a quality improvement initiative to assess initiating the protocol, identifying at-risk patients, and making appropriate referrals. Methods The initial visit of adults (ages 19 and over) seen over a one year period were retrospectively reviewed. For adults screening positive in the EMR, a Data Collection Form was completed gathering information on PHQ-9 scores, mental health treatment and diagnosis, and burn injuries. Results There were 748 adults seen for an initial visit at the burn center, ages 19–85, 61% men and 39% women. Of those patients, 572 had a PHQ-9 score documented in the EMR, demonstrating a 76% compliance rate with administration. Of those screened, 52 met criteria for inclusion by scoring 10 or greater or endorsing the suicide risk question on the PHQ-9. Scoring ranges on the PHQ-9 were as follows (N=52): 15.4% mild; 50% moderate; 19.2% moderate-severe; and 15.4% severe. Sixty percent of patients endorsed some suicidal ideation. Fifty two percent of patients were documented clearly as being on psychotropic medication or in specialized mental health services. Results were reviewed or discussed with patients in 81% of the initial visit notes. Nineteen of the 52 patients were offered a referral for mental health services. Conclusions Initiating this protocol creates an opportunity to begin conversations about mental health and offer additional support to patients. Approximately 9% of the outpatients screened at the burn center endorsed significant symptoms of depression and or suicidal ideation. Nearly half of these patients were not actively receiving treatment for these symptoms and could potentially benefit from mental health services. This project highlighted that compliance with administering and documenting the PHQ-9 and referral for follow-up services could be improved at this institution. Applicability of Research to Practice This protocol supports the need for continued evaluation and screening for depression and suicide risk in adult burn patients. Consideration should be given for monitoring other mental health conditions that could create barriers to care or compliance with treatment, such as anxiety, PTSD, psychosis, etc.

Depression screening in adults with diabetes

Depression screening in adults with diabetes

The Importance of Screening for Mild Depression in Adults with Diabetes

Aim: While the impact of major depression on diabetes has gained increasing attention, the role of minor depression is less well investigated. This observational study compared three groups of adults with Type 1 (T1DM) or Type 2 (T2DM) diabetes mellitus: with me) no depressive symptoms (NODEP), ii) mild depressive symptoms (MILD) and iii) moderate-to-severe symptoms (MOD/SEVERE)-on diabetes distress, psychological distress, anxiety and somatic symptoms, quality of life and HbA1c levels. Methods: 245 outpatients attending two hospital diabetes services (27% with T1DM; 73% with T2DM) completed self-report measures including patient health questionnaire (PHQ), problem areas in diabetes (PAID) scale and short form health survey (SF12). Participants were interviewed by a psychiatrist and HbA1c levels recorded. Results: Half the sample reported depressive symptoms on the PHQ-9 (29% in the MILD group, 21% in MOD/ SEVERE and the remaining 50% in the NODEP group). Compared to the NODEP group, MILD group participants had significantly higher levels of diabetes distress, psychological distress, anxiety and somatic symptoms and significantly lower mental-health related quality of life. Participants in the MOD/SEVERE group had significantly higher levels of diabetes distress, psychological distress, anxiety, and somatic symptoms than either of the other two groups, and significantly lower quality of life. The groups did not differ significantly on HbA1c. Conclusions: Mild symptoms of depression in patients with diabetes are common and are associated with higher levels of diabetes distress, psychological distress, anxiety and somatic symptoms and lower quality of life. Addressing mild depression provides a potential avenue for preventing clinical depression in patients with diabetes.

Screening for Depression in Adults

Description Update of the 2009 US Preventive Services Task Force (USPSTF) recommendation on screening for depression in adults. Methods The USPSTF reviewed the evidence on the benefits and harms of screening for depression in adult populations, including older adults and pregnant and postpartum women; the accuracy of depression screening instruments; and the benefits and harms of depression treatment in these populations. Population This recommendation applies to adults 18 years and older. Recommendation The USPSTF recommends screening for depression in the general adult population, including pregnant and postpartum women. Screening should be implemented with adequate systems in place to ensure accurate diagnosis, effective treatment, and appropriate follow-up. (B recommendation)

Screening for Depression—A Tale of Two Questions

The US Preventive Services Task Force (USPSTF)1 has issued new recommendations on Screening for Depression inwhich they concluded, “TheUSPSTF recommends screening for depression in the general adult population, including pregnant and postpartum women. Screening should be implemented with adequate systems in place to ensure accuratediagnosis, effective treatment, andappropriate follow-up (B recommendation).”GradeB indicateshighcertainty that the netbenefit ismoderateormoderate certainty that thenetbenefit is moderate to substantial. An “adequate system” includes a depression care manager who ensures that patients are screened and, if they screen positive for depression, appropriatelydiagnosedandtreatedwithevidence-basedstepped careor referred toa setting that canprovide thenecessarycare. The newguidelines are similar to the 2002 and 2009USPSTF depression screening recommendations except for 1 major change:neither the2002nor the2009recommendationsmentioned pregnant or postpartumwomen.2,3 The recentUSPSTF recommendations are largelybasedon a systematic review evaluating the potential benefits of depressionscreening inpregnantorpostpartumwomen.4Nonew randomized trials of depression screening in (nonpregnant or postpartum) adults have been added since the 2009 guidelines. One example of the new studies included in the USPSTF systematic review was a trial that randomized 462 postpartum women (who were not already receiving psychiatric treatment) toadepressionscreening interventionvsusual care.5 Intervention groupparticipants completed the 10-item Edinburgh Postnatal Depression Scale (EPDS); control group participants completed a general self-efficacy scale (similar in length and format) but didnot complete theEPDS.All participants underwent a clinical assessment by a nurse who was blinded to their group allocation; patients (fromeither group) who were assessed by this nurse as having probable postnatal depression were referred for further evaluation and treatment. Intervention patients with an EDPS score of at least 10 (or any suicidal ideation)were referred for further evaluation and treatment (regardless of the clinical assessment). In an intention to treat analysis, 13% of the intervention group and 22.1% of the control group had EDPS scores of at least 10 at 6 months (risk ratio, 0.59; 95% CI, 0.39-0.89; number needed to screen, 11). Basedon this andother studies, theUSPSTFconcluded that screening results in the reduction or remission of depression symptoms and that the magnitude of harms of screening for depression in adults is small to none. Whether the available evidence justifies routine screening of unselected adults for depression is debatable. Notably, the Canadian Task Force on Preventive Health Care does not recommend routine screening for depression in adults at average risk.6 However, multiple other organizations (eg, American Academy of Family Physicians, American College of Physicians,AmericanCollegeofObstetriciansandGynecologists)do recommendroutinescreeningfordepression,especially forsubgroupsofpatientswhoareathighrisk, suchaspersonswith low socioeconomic status, limitedsocial support, chronicpain,disability, unintended pregnancy, comorbid mental health issues, or chronicmedical conditions.Moreover,most US insuranceproviders, including theCenter forMedicareandMedicaid Services, coverannual screening fordepression inprimarycare settingsthathavestaff-assisteddepressioncaresupports inplace to assure accurate diagnosis, effective treatment, and followup.Therefore,primarycarecliniciansmustbefamiliarwithhow to implement a depression screening program.

Implementing Recommendations for Depression Screening of Adults

TheUSPreventiveServicesTaskForce (USPSTF)hasoffered its updated recommendations for the screening for depression in adults. The document, published thisweek in JAMA,1 updates a 2009 review of the evidence as to the net benefit of accurate diagnosis,effectivetreatment, andappropriate follow-upafter depression screening for adults older than 18 years, including pregnant and postpartum women, complementing previousrecommendationsfordepressionscreening inchildren and adolescents (http://www.uspreventiveservicetaskforce .org). There is no question that primary care screening offers a first-line medical opportunity to identify patients with an undiagnosed major depressive episode. Use of standardized screening instruments and evidence-based treatments are a critical first step. That said, anunsettling reality remains: how, even with improved efficiency of screening and more timely diagnoses,dowesecure thenecessary resources toensure that depressed patients not only receive treatment and follow-up, but that the treatment selected is both appropriate and optimized for the individual. Compounding these challenges, neurological patients with depression, even when identified, maybereticenttoacceptpsychiatrictreatment,2andlikeinternal medicine and primary care, the time and resources needed to address the behavioral “symptoms” are often eclipsed by core demands of the principal neurological or medical condition. For apatientpresentingwithmajordepressiveepisode, an antidepressant medication or evidence-based psychotherapy is currently recommendedas first-line treatment,with remission rates to these 2options roughly equivalent in all patients except themost severely ill.3With thisperceivedequivalency, treatment selection is oftenbasedon factors suchaspatient and health care professional preference, cost and accessibility, andpotential adverse effects.However, theodds are actually against remission in patients currently treated using this approach. At best, 40% of patients achieve remission with a first treatment, and the “wrong” first choice has significant individual and societal costs due to continueddistress, risk of suicide, loss of productivity, and wasted resources associated with 2 to 3 months of an ineffective treatment.Moreover, among the roughly60%to70%ofdepressed patientswho do not remitwith their first treatment,many do not return to explore other options, with potential lethal consequences.4These sameconcernshold fordepressionpresenting inpatientswithneurological diseases andothermedical illnesses where the combined presence of a mood disorder has a magnified effect on disability.5 Clearly, treatments are highly effective in some individuals, but there is no reliableway tomatch patients to their best treatment option or to avoid those that are unlikely to be effective, even in the setting of equal access. Developing reliable biomarkers that can stratify individual patients to specific treatments is essential to achieve the goal of a more personalized level of care for patientswith depression and all neuropsychiatric disorders.6Manymedical specialties suchas those treating heart disease and cancer now routinely use patient-level biological measures to subtype and stratify patients to treatments, andtoguide treatmentmodificationswith disease progression or categories of disease risk, substantially improving patient outcomes. Toward a “precision medicine” approach for depression, various strategies have been tested, including clinical, imaging, genetic, electroencephalographic, and immunological metrics, but with limited clinical impact thus far. Motivated to translate ongoing advances in functional and structural neuroimaging methods and mounting evidence of (1) distinct patterns of brain dysfunction across clinically defined depression subgroups, (2) regional correlates of specific mood, motor, and cognitive syndrome dimensions, and (3) differential change patterns with mechanistically distinct treatments,7 investigations of brain-based biomarkers that predict treatment outcomes to standard first-line treatments have been initiated. Recent studies have identified some initial promising imaging biomarker candidates that predict remission and nonresponse to cognitive behavioral therapy or a standard selective serotonin reuptake inhibitor Related article at jama.com Opinion Editorial

Screening for Depression in Adults: US Preventive Services Task Force Recommendation Statement.

Update of the 2009 US Preventive Services Task Force (USPSTF) recommendation on screening for depression in adults. The USPSTF reviewed the evidence on the benefits and harms of screening for depression in adult populations, including older adults and pregnant and postpartum women; the accuracy of depression screening instruments; and the benefits and harms of depression treatment in these populations. This recommendation applies to adults 18 years and older. The USPSTF recommends screening for depression in the general adult population, including pregnant and postpartum women. Screening should be implemented with adequate systems in place to ensure accurate diagnosis, effective treatment, and appropriate follow-up. (B recommendation).

Primary Care Screening for and Treatment of Depression in Pregnant and Postpartum Women: Evidence Report and Systematic Review for the US Preventive Services Task Force.

Depression is a source of substantial burden for individuals and their families, including women during the pregnant and postpartum period. To systematically review the benefits and harms of depression screening and treatment, and accuracy of selected screening instruments, for pregnant and postpartum women. Evidence for depression screening in adults in general is available in the full report. MEDLINE, PubMed, PsycINFO, and the Cochrane Collaboration Registry of Controlled Trials through January 20, 2015; references; and government websites. English-language trials of benefits and harms of depression screening, depression treatment in pregnant and postpartum women with screen-detected depression, and diagnostic accuracy studies of depression screening instruments in pregnant and postpartum women. Two investigators independently reviewed abstracts and full-text articles and extracted data from fair- and good-quality studies. Random-effects meta-analysis was used to estimate the benefit of cognitive behavioral therapy (CBT) in pregnant and postpartum women. Depression remission, prevalence, symptoms, and related measures of depression recovery or response; sensitivity and specificity of selected screening measures to detect depression; and serious adverse effects of antidepressant treatment. Among pregnant and postpartum women 18 years and older, 6 trials (n = 11,869) showed 18% to 59% relative reductions with screening programs, or 2.1% to 9.1% absolute reductions, in the risk of depression at follow-up (3-5 months) after participation in programs involving depression screening, with or without additional treatment components, compared with usual care. Based on 23 studies (n = 5398), a cutoff of 13 on the English-language Edinburgh Postnatal Depression Scale demonstrated sensitivity ranging from 0.67 (95% CI, 0.18-0.96) to 1.00 (95% CI, 0.67-1.00) and specificity consistently 0.87 or higher. Data were sparse for Patient Health Questionnaire instruments. Pooled results for the benefit of CBT for pregnant and postpartum women with screen-detected depression showed an increase in the likelihood of remission (pooled relative risk, 1.34 [95% CI, 1.19-1.50]; No. of studies [K] = 10, I2 = 7.9%) compared with usual care, with absolute increases ranging from 6.2% to 34.6%. Observational evidence showed that second-generation antidepressant use during pregnancy may be associated with small increases in the risks of potentially serious harms. Direct and indirect evidence suggested that screening pregnant and postpartum women for depression may reduce depressive symptoms in women with depression and reduce the prevalence of depression in a given population. Evidence for pregnant women was sparser but was consistent with the evidence for postpartum women regarding the benefits of screening, the benefits of treatment, and screening instrument accuracy.

Screening for depression in adults: U.S. Preventive Services Task Force recommendation statement

Screening for depression in adults: U.S. Preventive Services Task Force recommendation statement

Validation of the Patient Health Questionnaire-9 (PHQ-9) for depression screening in adults with epilepsy

ObjectiveThis study aimed to assess the accuracy and operating characteristics of the Patient Health Questionnaire-9 (PHQ-9) for depression screening in adults with epilepsy. MethodsTertiary epilepsy center patients served as the study population, with 237 agreeing to structured interview using the Mini-International Neuropsychiatric Interview (MINI), a “gold standard” instrument developed for rapid diagnosis of neuropsychiatric disorders, including major depressive disorder (MDD); 172 also completed the PHQ-9, and 127 completed both the PHQ-9 and the Neurological Disorders Depression Inventory for Epilepsy (NDDI-E) within two days of the MINI. Sensitivity, specificity, positive and negative predictive values, and areas under the ROC curves for each instrument were determined. Cut-points of 10 for the PHQ-9 and 15 for the NDDI-E were used, and ratings at or above the cut-points were considered screen-positive. The PHQ-9 was divided into cognitive/affective (PHQ-9/CA) and somatic (PHQ-9/S) subscales to determine comparative depression screening accuracy. ResultsThe calculated areas under the ROC curves for the PHQ-9 (n=172) and the PHQ-9/CA and PHQ-9/S subscales were 0.914, 0.924, and 0.846, respectively, with the PHQ-9 more accurate than the PHQ-9/S (p=0.002) but not different from the PHQ-9/CA (p=0.378). At cut-points of 10 and 15, respectively, the PHQ-9 had higher sensitivity (0.92 vs 0.87) but lower specificity (0.74 vs 0.89) compared with the NDDI-E. The areas under the ROC curves of the PHQ-9 and the NDDI-E showed similar accuracy (n=127; 0.930 vs 0.934; p=0.864). SignificanceThe PHQ-9 is an efficient and nonproprietary depression screening instrument with excellent accuracy validated for use in adult patients with epilepsy as well as multiple other medical populations.

Screening for depression: a systematic review and meta-analysis.

The Canadian Task Force on Preventive Health Care has a guideline on screening for depression among adults 18 years of age or older at average or high risk for depression. To provide evidence for an update of this guideline, we evaluated the literature on the effectiveness of screening for depression in adults. For the period 1994 to May 23, 2012, we searched the following electronic databases: MEDLINE, Embase, PsycINFO, the Cochrane Central Register of Controlled Trials and the Cochrane Database of Systematic Reviews. Randomized controlled trials, observational studies and systematic reviews with evidence for the benefits or harms of screening for depression were eligible for inclusion. We performed screening for relevance, extraction of data, analysis of risk of bias and quality assessments in duplicate. We used the generic inverse variance method to conduct a meta-analysis. To determine confidence in the effect, we analyzed the results according to the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system. Five quasi-experimental studies (before-after design with a nonrandomized control group) met the inclusion criteria for this review. These studies reported on the effect of community-based screening for depression, with follow-up on the risk of suicide completion, for older residents in regions of rural Japan with high suicide rates. Meta-analysis showed that the screening program had a protective effect on the overall incidence of suicide completion (ratio of rate ratios [RRR] 0.50, 95% confidence interval [CI], 0.32-0.78). When sex was considered, the RRR indicated a significantly lower rate of suicide among women (RRR 0.37, 95% CI 0.21-0.66) but not among men (RRR 0.67, 95% CI 0.35-1.27). The overall GRADE rating applied to this evidence indicated very low quality. No studies addressing the harms of screening for depression met the inclusion criteria for the review. There is very limited research evidence allowing conclusions about the effectiveness of screening for depression in either average-risk or high-risk populations.

Recommendations on screening for depression in adults

See related commentary by Bland and Streiner on page [753][1] and at [www.cmaj.ca/lookup/doi/10.1503/cmaj.130634][2] Depression is a mood disorder that affects the way a person feels, thinks or behaves, which may impair social or occupational functioning.[1][3] The onset of depression can be

Prevalence of depression in adults with haemophilia

Multiple factors place adults with haemophilia at risk for depression. Health outcomes can be compromised in depressed patients secondary to increased risk taking behaviour and poor compliance with treatment recommendations. To assess the prevalence and risk factors associated with depression in adult patients with haemophilia treated at a haemophilia treatment centre. Adults with haemophilia were screened for depression during their annual clinic visit using the Patient Health Questionnaire 9 (PHQ-9), a validated tool for depression screening in adults. Depression was defined as a PHQ-9 score ≥ 5. Risk factors associated with depression were collected by chart review and correlated with depression scores. A total of 41 adult patients consented to the study and 37% met criteria for depression. Fifty-three per cent of patients with depression reported moderate to severe symptoms of depression (PHQ-9 score >10). Seventy-six per cent of patients with depression reported suffering functional impairment due to their depressive symptoms. Lack of social support and unemployment were significantly associated with higher PHQ-9 scores (P = 0.04 and P = 0.01 respectively). Adult patients with haemophilia have a high prevalence of depression. The addition of depression screening to the comprehensive care of adults with haemophilia may result in improved overall health outcomes and treatment adherence.

Prioritizing research needs based on a systematic evidence review: a pilot process for engaging stakeholders

Systematic evidence reviews (SERs) identify knowledge gaps in the literature, a logical starting place for prioritizing future research. Varied methods have been used to elicit diverse stakeholders' input in such prioritization. To pilot a simple, easily replicable process for simultaneously soliciting consumer, clinician and researcher input in the identification of research priorities, based on the results of the 2009 SER on screening adults for depression in primary care. We recruited 20 clinicians, clinic staff, researchers and patient advocates to participate in a half-day event in October 2009. We presented SER research methods and the results of the 2009 SER. Participants took part in focus groups, organized by profession; broad themes from these groups were then prioritized in a formal exercise. The focus group content was also subsequently analysed for specific themes. Focus group themes generally reacted to the evidence presented; few were articulated as research questions. Themes included the need for resources to respond to positive depression screens, the impact of depression screening on delivery systems, concerns that screening tools do not address comorbid or situational causes of depression and a perceived 'disconnect' between screening and treatment. The two highest-priority themes were the system effects of screening for depression and whether depression screening effectively leads to improved treatment. We successfully piloted a simple, half-day, easily replicable multi-stakeholder engagement process based on the results of a recent SER. We recommend a number of potential improvements in future endeavours to replicate this process.

Screening for Depression in Adults: U.S. Preventive Services Task Force Recommendations

Screening for Depression in Adults: U.S. Preventive Services Task Force Recommendations

Screening for Depression in Adults: U.S. Preventive Services Task Force Recommendation Statement

Update of the 2002 U.S. Preventive Services Task Force (USPSTF) recommendation statement on screening for depression in adults. The USPSTF examined evidence on the benefits and harms of screening primary care patients for depression, including direct evidence that depression screening programs improve health outcomes. The USPSTF did not reexamine evidence for those key questions that had strong, consistent evidence in the 2002 review, including questions about the accuracy of screening instruments in identifying depressed adult patients in primary care settings, and the efficacy of treatment of depressed adults with antidepressants or psychotherapy. New areas of evidence considered for this review (and not reviewed in 2002) include efficacy of treatment of depression in older adult patients, harms of screening for depression in primary care settings, and adverse events from treatment of depression in adults. The USPSTF recommends screening adults for depression when staff-assisted depression care supports are in place to assure accurate diagnosis, effective treatment, and follow-up. (Grade B recommendation) The USPSTF recommends against routinely screening adults for depression when staff-assisted depression care supports are not in place. There may be considerations that support screening for depression in an individual patient. (Grade C recommendation).

Screening for Depression in Adults

Screening for Depression in Adults