A new analysis concludes that routine screening for depression in primary care patients is costly, not clinically effective, and may lead to false positives.
In the study, Canadian researchers discovered routine screening has not proved beneficial and is not an effective use of health care funds. Instead, funds might be better used for providing more consistent treatment for people already diagnosed with depression.
Screening for depression is a contentious topic as most authorities believe a significant number of individuals go undiagnosed. However, clinical evidence supporting treatment for mild to moderate bouts of depression has not been validated.
Nevertheless, screening for depression by primary care providers is recommended in the United States and Canada as long as medical and mental health programming and resources are available for followup and treatment for depression.
By contrast, the United Kingdom does not recommend screening because of a lack of evidence supporting its efficacy.
The UK’s National Institute for Health and Clinical Excellence guidelines cited concerns about high rates of false-positive results, lack of evidence of benefit, high cost and large amount of resources, and the diversion of resources away from people with serious depression.
“The prevalence of depression and the availability of easy-to-use screening instruments make it tempting to endorse widespread screening for the disease,” wrote co-author Brett Thombs, Ph.D., of McGill University.
“However, screening in primary care is a resource-intensive endeavor, does not yet show evidence of benefit and would have unintended negative effects for some patients.”
Experts say that screening is beneficial when it can identify people with an unrecognized and untreated condition that will improve with treatment. Many instances of mild depression resolve without intervention.
The authors recommend that providing consistent treatment to people with recurrent depression would be a more effective way of dealing with this disease than general screening.
Unequivocally, researchers say clinical trials are needed to evaluate the efficacy of screening. Then, evidence-based recommendations can be drafted.
Until then, “Given the lack of evidence of benefit from screening and the concerns that we have described, it is not reasonable to simply assume that depression screening is good policy,” the authors concluded.
The analysis is found in the Canadian Medical Association Journal .