USPSTF issues draft recommending screening for depression in all adults
Screening should be implemented with “adequate systems in place to ensure accurate diagnosis, effective treatment, and appropriate followup.”
The U.S. Preventive Services Task Force (USPSTF) recommended screening for depression in the general adult population in a draft of an update to its 2009 recommendations.
The task force outlined the proposed update in a draft recommendation statement, which is open for comment through Aug. 24. The USPSTF in 2009 recommended screening all adults when staff-assisted depression care supports are in place and, when such supports are not available, selectively screening based on professional judgment and patient preferences.
“In recognition that such support is now much more widely available and accepted as part of mental health care, the current recommendation statement has omitted the recommendation regarding selective screening, as it is no longer representative of current clinical practice,” the draft's authors wrote. The current statement also includes a recommendation for screening pregnant and postpartum women for depression, whereas the prior document did not specifically review these subpopulations.
The draft stated that depression screening should be implemented with “adequate systems in place to ensure accurate diagnosis, effective treatment, and appropriate followup.” According to the USPSTF, “adequate systems in place” refers to systems and clinical staff that support the primary care clinician by providing some direct depression care, such as administration of questionnaires or case management.
This support could be a designated nurse who advises physicians of positive screening results and provides a protocol that facilitates referral to behavioral treatment, according to the statement. Higher levels of support outlined in the draft include staff and clinician training, an initial visit with a nurse specialist for assessment, a visit with a trained therapist for cognitive behavioral therapy, and a reduced copay for patients referred for psychotherapy.
The USPSTF based its recommendation on the benefits and harms of depression screening, although it did not consider the costs of providing the service. The B-grade recommendation suggests either that there is high certainty that the net benefit is moderate or there is moderate certainty that the net benefit is moderate to substantial.
The draft notes a need for future research to identify the optimal screening interval in all populations, as well as to determine the optimal screening approaches in older adults. Data are also lacking on both the accuracy of screening and the benefits and harms of treatment in pregnant women, as well as the balance of benefits and harms of treatment with antidepressants in postpartum women, according to the USPSTF. The task force encourages clinicians to consider the severity of depression and the benefits and harms of different treatments in pregnant or breastfeeding patients.