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USPSTF recommends depression screening for adults, including pregnant and postpartum women

The US Preventive Services Task Force has issued recommendations regarding screening for depression in adults, including pregnant and postpartum women, for the first time.

According to the agency, depression screening "should be implemented with adequate systems in place to ensure accurate diagnosis, effective treatment and appropriate follow-up."

Albert L. Siu, MD, MSPH, professor at Mount Sinai School of Medicine, and the USPSTF published their recommendations in JAMA with a B grade, meaning that there is certainty the net benefit ranges from moderate to substantial.

"Depression is among the leading causes of disability in persons 15 years and older," the authors wrote. "It affects individuals, families, businesses and society and is common in patients seeking care in the primary care setting. Depression is also common in postpartum and pregnant women and affects not only the woman but her child as well. 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."

The USPSTF reported evidence that supported early detection, intervention and treatment, including improved clinical outcomes, decreased clinical morbidity and low likelihood of serious harms.

The advice serves as an update to its 2009 guidelines, and recommends that all adults 18 years and older are screened for depression, particularly pregnant and postpartum women.

The Task Force highlighted its definition of adequate systems includes having systems and staff necessary to screen patients, as well as appropriate diagnosis, evidence-based treatment or referral if patients do screen positive.

"These essential functions can be provided through a wide range of different arrangements of clinician types and settings," the authors wrote. "In the available evidence, the lowest effective level of support consisted of a designated nurse who advised resident physicians of positive screening results and provided a protocol that facilitated referral to evidence-based behavioral treatment. At the highest level, support included screening; staff and clinician training (1- or 2-day workshops); clinician manuals; monthly training lectures; academic detailing; materials for clinicians, staff and patients; an initial visit with a nurse specialist for assessment, education and discussion of patient preferences and goals; a visit with a trained nurse specialist for follow-up assessment and ongoing support for medication adherence; a visit with a trained therapist for [cognitive behavioral therapy]; and a reduced copayment for patients referred for psychotherapy."

The USPSTF recommended depression screening for all adults, but noted various risk factors for specific populations. Young or middle-aged adults, women and nonwhites have higher rates of depression, along with patients with chronic illness, other mental disorders or a family history of mental disorders. Older adults are at a higher risk for depression if they have issues such as a disability or loneliness, and pregnant or postpartum women are at a higher risk if they have child-care stress, anxiety or decreased social support.

The recommendations stated that there was no known timing for optimal screening, but commonly-used tests include "the Patient Health Questionnaire (PHQ) in various forms and the Hospital Anxiety and Depression Scales in adults, the Geriatric Depression Scale in older adults, and the Edinburgh Postnatal Depression Scale (EPDS) in postpartum and pregnant women."

In an accompanying editorial published in JAMA Internal Medicine, Mary A. Whooley, MD, FACP, FAHA, FACC, San Francisco VA Health Care System, wrote that her previous research demonstrated that two yes-or-no questions from the Primary Care Evaluation of Mental Disorders (PRIME-MD) was effective in screening for depression. The questions asked patients if, during the past month, they have often been bothered by feeling down, depressed or hopeless or little interest or pleasure in doing things.

"Two simple yes/no questions are highly sensitive, easy to administer, and take less than 1 minute to complete and score," she wrote. "A 'no' response to both questions effectively rules out depression so that no further evaluation is necessary."

The USPSTF also acknowledged the lack of large-scale randomized controlled trials on depression screening in primary care for older adults, and called for more research on accuracy, optimal screening intervals and barriers to care. – by Chelsea Frajerman Pardes

Disclosures: Whooley reported no relevant financial disclosures. Please see the full studies for a complete list of all relevant financial disclosures.