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Experts Call for MDs to Screen Adults for Depression

Experts Call for MDs to Screen Adults for Depression

A new report by the U.S. Preventive Services Task Force (USPSTF) recommends that primary care providers screen the general adult population for depression, including pregnant and postpartum women.

The task force also advises that the screening should be implemented with adequate systems in place to ensure accurate diagnosis, effective treatment, and appropriate follow-up. The report appears in the Journal of the American Medical Association (JAMA).

Technically, this recommendation is a grade B recommendation, meaning that there is high certainty that the net benefit is moderate, or there is moderate certainty that the net benefit is moderate to substantial.

Currently, depression is among the leading causes of disability in persons 15 years and older. It affects individuals, families, businesses, and society and is common in patients seeking care in the primary care setting, and also common in postpartum and pregnant women.

The U.S. Preventive Services Task Force (USPSTF) reviewed the evidence in the medical literature on the benefits and harms of screening for depression in adult populations.

The task force specifically looked at the effects on special 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.

The USPSTF is an independent, volunteer panel of experts that makes recommendations about the effectiveness of specific preventive care services such as screenings, counseling services, and preventive medications. This report is an update of a 2009 USPSTF recommendation statement. The USPSTF continues to recommend that adults 18 and older be screened for depression.

The USPSTF found convincing evidence that screening improves the accurate identification of adult patients with depression in primary care settings, including pregnant and postpartum women.

They also found adequate evidence that programs combining depression screening with adequate support systems in place improve clinical outcomes (i.e., reduction or remission of depression symptoms) in adults, including pregnant and postpartum women.

Moreover, the USPSTF found convincing evidence that treatment of adults and older adults with depression identified through screening in primary care settings with antidepressants, psychotherapy, or both improves outcomes.

They also found adequate evidence that treatment with cognitive behavioral therapy (CBT) improves clinical outcomes in pregnant and postpartum women with depression.

A current issue for many public health initiatives is whether a screen is helpful or potentially harmful if false negatives result — that is, if a screen incorrectly suggests a person may have a disease or illness.

In this case, the USPSTF found adequate evidence that the magnitude of harms of screening for depression in adults is small to none and that the magnitude of harms of treatment with CBT in postpartum and pregnant women is small to none.

Researchers also found that second-generation antidepressants (mostly selective serotonin reuptake inhibitors [SSRIs]) are associated with some harms. For example, an increase in suicidal behaviors in adults age 18 to 29 years and an increased risk of upper gastrointestinal bleeding in adults older than 70 years, with risk increasing with age. However, the magnitude of these risks is, on average, small.

The USPSTF also found evidence of potential serious fetal harms from pharmacologic treatment of depression in pregnant women, but the likelihood of these serious harms is low. Therefore, the USPSTF concludes that the overall magnitude of harms is small to moderate.

The next issue is knowing when to perform the screen.

The optimal timing and interval for screening for depression is not known. A pragmatic approach might include screening all adults who have not been screened previously and using clinical judgment in consideration of risk factors, medical issues, and life events to determine if additional screening of high-risk patients is warranted.

Positive screening results should lead to additional assessment that considers severity of depression, review of associated psychological problems, alternate diagnoses, and medical conditions.

Effective treatment of depression in adults generally includes antidepressants or specific psychotherapy approaches, alone or in combination. Given the potential harms to the fetus and newborn child from certain pharmacologic agents, clinicians are encouraged to consider evidence-based counseling interventions when managing depression in pregnant or breastfeeding women.

Source: JAMA/EurekAlert
 
Doctor comforting a patient photo by shutterstock.

Experts Call for MDs to Screen Adults for Depression

Rick Nauert PhD

Rick Nauert, PhDDr. Rick Nauert has over 25 years experience in clinical, administrative and academic healthcare. He is currently an associate professor for Rocky Mountain University of Health Professionals doctoral program in health promotion and wellness. Dr. Nauert began his career as a clinical physical therapist and served as a regional manager for a publicly traded multidisciplinary rehabilitation agency for 12 years. He has masters degrees in health-fitness management and healthcare administration and a doctoral degree from The University of Texas at Austin focused on health care informatics, health administration, health education and health policy. His research efforts included the area of telehealth with a specialty in disease management.

APA Reference
Nauert PhD, R. (2016). Experts Call for MDs to Screen Adults for Depression. Psych Central. Retrieved on August 17, 2018, from https://psychcentral.com/news/2016/01/27/experts-call-for-mds-to-screen-adults-for-depression/98264.html

 

Scientifically Reviewed
Last updated: 27 Jan 2016
Last reviewed: By John M. Grohol, Psy.D. on 27 Jan 2016
Published on PsychCentral.com. All rights reserved.