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USPSTF depression screening recommendation highlights primary care, mental health integration

The recently updated U.S. Preventive Services Task Force recommendation for depression screening in children and adolescents provides the opportunity to address the significance and feasibility of integrating primary care and mental health care.

The U.S. Preventive Services Task Force (USPSTF) recently updated its recommendations for depression screening in children and adolescents, reaffirming its 2009 recommendation to screen adolescents aged 12 to 18 years for major depressive disorder.

The recommendation mirrors the 2015 USPSTF draft statement on depression screening in adults, endorsing screening in adults, including pregnant and postpartum women.

“Screening alone improves recognition and may slightly increase treatment, but it is insufficient to improve clinical outcomes. Thus, the USPSTF recommends that screening be implemented in settings with resources to ensure follow-up for accurate diagnosis and effective treatment,” John W. Williams Jr., MD, MHSc, of Durham Veterans Affairs Medical Center, North Carolina, and Gary Maslow, MD, MPH, of Duke University, Durham wrote in an accompanying editorial. “Models that integrate primary and mental health care have consistently shown better clinical outcomes than usual care and have been shown to be effective for adults and adolescents.”

Further, the task force recommends clinicians choose between second-generation antidepressants or cognitive behavioral therapy (CBT) to treat major depression after discussing treatment effects, adverse effects, cost, accessibility, and preferences with the patient. This recommendation was based on moderate-quality evidence of no differences in treatment response or discontinuation between second-generation antidepressants and CBT.

Williams and Maslow suggest clinicians use the Patient Health Questionnaire for Adolescents and Beck Depression Inventory for depression screening in adolescents, based on their outperformance in previous research.

They also suggest the Patient Health Questionnaire for depression screening in adults.

For practices initiating depression screening, it may be beneficial to screen in conjunction with routine health visits, targeting individuals with symptoms associated with depression, such as insomnia, or other risk factors.

Clinical reminders can be used in practices with electronic health records to prompt staff to distribute screening questionnaires or verbally administer questions.

To successfully implement depression screening, all staff should understand the significance of screening, confidentiality, how to introduce screening to patients and the need to administer screening questions verbatim, according to Williams and Maslow.

“The ACP treatment guideline appropriately emphasizes discussion with patients about treatment benefits, adverse effect profiles, costs, accessibility and preferences. This recommendation is consistent with the principles of shared decision making. Incorporating these principles and decision aids could address the current mismatch between the treatment desired and the treatment received by patients with depression,” Williams and Maslow concluded. – by Amanda Oldt

Disclosure: Williams reports personal fees from Center for Medicare & Medicaid Innovations Center, personal fees from Healthwise, outside the submitted work. Maslow reports no relevant financial disclosures.