All adults age 18 and older in the general population—including pregnant and postpartum women—should be screened for depression, according to newly updated guidelines from the United States Preventative Services Task Force (USPSTF).
The update, which expands upon the panel’s 2009 recommendations, follows an extensive systematic review of existing evidence on mental illness and the benefits of depression screening, according to a statement published online Jan. 26 in JAMA.
“The USPSTF concludes with at least moderate certainty that there is a moderate net benefit to screening for depression in adults, including older adults, who receive care in clinical practices that have adequate systems in place to ensure accurate diagnosis, effective treatment, and appropriate follow-up after screening,” wrote author Albert Siu, MD, task force member and professor of General Internal Medicine at Mount Sinai Hospital in New York City. “The USPSTF also concludes with at least moderate certainty that there is a moderate net benefit to screening for depression in pregnant and postpartum women who receive care in clinical practices that have CBT or other evidence-based counseling available after screening.”
Mental illness and depression are among the leading causes of disability in Americans over the age of 15 and is common in postpartum and pregnant women, affecting not only individuals but families and children as well. There isn’t simply a human cost, however—an estimated $22.8 billion was spent on depression treatment nationwide in 2009, with the cost of lost productivity estimated to be $23 billion in 2011.
But practical preventative factors such as when and how often to screen for depression are still unknown, said the USPSTF, so clinicians must use their best judgement in the primary care setting.
“A pragmatic approach in the absence of data might include screening all adults who have not been screened previously and using clinical judgment in consideration of risk factors, comorbid conditions, and life events to determine if additional screening of high-risk patients is warranted,” the recommendations state.
Methods currently available for depression screening include the Patient Health Questionnaire and the Hospital Anxiety and Depression Scales in adults; the Geriatric Depression Scale in older adults; and the Edinburgh Postnatal Depression Scale in postpartum and pregnant women.
When it comes to diagnosing and treating the disease, the USPSTF believes the evidence supports a need for collaborative effort from all corners of the healthcare community.
“Multidisciplinary team-based primary care that includes self-management support and care coordination has been shown to be effective in management of depression,” the statement added. “Research is needed to assess barriers to establishing adequate systems of care and how these barriers can be addressed.”
With more attention now focused on the disease and a growing movement to effectively prevent, diagnose and treat those affected by depression, the USPSTF believes the scope of combined screening efforts should match the impact of the problem at hand.
“Major depressive disorder is a common and significant health care problem,” wrote Siu. “The USPSTF recommends screening in all adults regardless of risk factors.”
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