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Psychiatrists support recent USPSTF recommendation for depression screening

The recent U.S. Preventive Services Task Force Recommendation for depression screening in the general adult population, including pregnant and postpartum women, highlights a significant integration of behavioral health services and primary care medicine, according to researchers.

The recommendation suggests physicians use brief, self-report instruments such as the Patient Health Questionnaire 9, which can be completed in under 5 minutes.

“In our view, this recommendation, while more limited in scope than is warranted by the available data, is nonetheless of first-rank importance, given the immense public health burden of depression across the life cycle and its downstream sequelae,” Charles F. Reynolds III, MD, and Ellen Frank, PhD, of Western Psychiatric Institute and Clinic of University of Pittsburgh Medical Center, Pennsylvania, wrote in an editorial.

While the USPSTF recommendation exemplifies the importance of integrating behavioral health and primary care medicine, it does not place adequate emphasis on major depression as a recurring, chronic condition, according to Reynolds and Frank.

“Simply stated, it is not enough to get well — staying well is also important, vitally so, because with each recurrent episode, the risk for chronicity and treatment resistance increases,” they wrote. “Our view is that the risk architecture inherent in major depression should inform recommendations for screening intervals, especially in patients who have experienced episodes of major depression.”

Nevertheless, Reynolds and Frank note that the recommendation statement provides an accurate description of risk architecture for depression at different time points in adult life, including pregnancy and postpartum periods and in older adults.

The statement also correctly describes the principal psychosocial and clinical determinants of risk for major depression, according to researchers.

“When all is said and done, we must finally recognize that depression is toxic to the brain. It erodes healthy brain aging and cognitive fitness across the adult life span,” Reynolds and Frank wrote. “The USPSTF recommendation makes the case for the importance of screening for depression and for the infrastructure needed to manage its antecedent, concurrent and downstream risks. This is an important milestone in the journey toward healthy equity, but that journey is long, with miles to go.” – by Amanda Oldt

Disclosure: Reynolds reports receiving pharmaceutical support for NIH-sponsored research studies from Bristol-Myers Squibb, Forest, Pfizer, and Lilly; receiving grants from the NIMH, National Institute on Aging, National Center for Minority Health Disparities, National Heart, Lung, and Blood Institute, Center for Medicare and Medicaid Services, Patient-Centered Outcomes Research Institute, the Commonwealth of Pennsylvania, the John A. Hartford Foundation, National Palliative Care Research Center, Clinical and Translational Science Institute, and the American Foundation for Suicide Prevention; and serving on the American Association for Geriatric Psychiatry editorial review board. He reports receiving honorarium as a speaker from MedScape/WEB MD and is the coinventor (Licensed Intellectual Property) of psychometric analysis of the Pittsburgh Sleep Quality Index PRO10050447. Please see the full study for a list of all authors’ relevant financial disclosures.