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USPSTF Says Most Adults Should be Screened for Depression

It is estimated that around 1 in 10 Americans experience depression at some point in their lifetimes with Major Depression affecting approximately 7% of the total U.S. Population. With statistics like these, it’s not surprising then that according to a recent draft recommendation issued by the U.S. Preventative Service Task Force, all adults should be screened for depression including “pregnant and postpartum women”.

Survey of Participants Screened for Depression

In a previous 2009 recommendation, the USPSTF stated that adults should be screened “when staff-assisted depression care supports are in place, and selective screening based on professional judgment and patient preferences when such support is not available.” However, they have since amended this recommendation and they now suggest that doctors should screen all patients 18 and older for depression using the Patient Health Questionnaire, or PHQ. The PHQ is currently the most commonly used tool for screening patients for depression. The survey includes 9 questions which are meant to assess the individual’s overall mental health. For example, the PHQ may ask “Over the last 2 weeks have you been feeling tired or having very little energy?” or “Over the last 2 weeks have you had little interest or pleasure in doing things?” Patients are supposed to mark their answer on a 0-3 scale ranging from “not at all” to “nearly every day”. The scores are then added up to diagnose whether or not the patient is suffering from mild to severe depression. Such diagnosis will then help their doctor determine what treatment may be best for them.

Why Recommend Depression Screening?

But why the change in recommendation? According to the USPSTF, “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.” In other words, the wide acceptance and increased availability of mental health care has effectively reduced some of the stigma regarding mental health screenings and diagnoses. The USPSTF also reports that “Depression is among the leading causes of disability in persons age 15 years or older. It affects individuals, families, businesses, and society. It is common in primary care patients. Depression is also common in postpartum and pregnant women and affects not only the woman but her child as well.” These facts and statistics have effectively contributed to the USPSTF’s stance on depression screenings and now they advise that general screening can potentially help with early detection and treatment of depression and depressive symptoms.

And according to the USPSTF, early detection and treatment can be highly beneficial. The USPSTF states that they have 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…that treatment of adults and older adults with depression identified through screening in primary care settings with antidepressants, psychotherapy, or both decreases clinical morbidity…[and] that treatment with cognitive behavioral therapy (CBT) improves clinical outcomes in pregnant and postpartum women with depression.” But what about the consequences of early detection and treatment? According to the USPSTF there are little to  none. Of course, women who are pregnant will likely need to be more careful about what medications they are taking while pregnant, but other treatments like CBT can be used alternatively or in conjunction with medication to treat depression.

The USPSTF insists that all adults be screened regardless of risk factors as such screenings are beneficial to the general adult population.Dr. Kristen Bibbins-Domingo, vice-chair of the USPSTF, explains that “Depression is not only common, it is one of the leading causes of disability in the United States. The Task Force’s recommendation for all adults to be screened by their primary care physician will help to identify depression and connect patients with the treatment and support they need.”

Official Announcement to be Made in Late August

Medical News Today reports that the “The USPSTF is taking public comment on the recommendation until August 24th. The expert panel will review all comments before making their final recommendation.” However, the USPSTF has made it clear that when it comes to depression, it’s important to screen early for maximum treatment benefit. With the lessened stigma surrounding mental health care, perhaps this new recommendation can be what’s needed to raise awareness about depression and provide necessary treatment to those who may not have previously had access.

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