USPSTF Finalizes Recommendations on Depression Screening in Adults

By Amy Orciari Herman

Edited by David G. Fairchild, MD, MPH, and Lorenzo Di Francesco, MD, FACP, FHM

All adults, including pregnant and postpartum women, should be screened for depression in primary care settings, according to new recommendations from the U.S. Preventive Services Task Force. The grade B recommendation updates the group's 2009 guidance, which didn't specifically address screening during pregnancy or the postpartum period.

The task force found "adequate evidence" that screening with "adequate systems in place to ensure accurate diagnosis, effective treatment, and appropriate follow-up" improves depressive symptoms in adults. In addition, it found "convincing evidence" that treatment with antidepressants or psychotherapy reduces morbidity in adults with screen-detected depression, and "adequate evidence" that cognitive behavioral therapy improves outcomes in pregnant and postpartum women with depression.

While the optimal screening interval is unknown, the USPSTF says "a pragmatic approach" might be to screen all those who haven't been previously screened, and to take risk factors, comorbidities, and life events into account to decide whether subsequent screenings are needed.

Dr. Thomas Schwenk of NEJM Journal Watch General Medicine notes that "the operative phrase is 'with adequate systems in place' ... The lack of such systems in many communities, for much insurance coverage, and for many patients, makes these recommendations difficult to implement."