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USPSTF 2023: Screening recommended for depression in adults, including in pregnant and postpartum persons (B recommendation)
Clinical Question
Should primary care clinicians screen asymptomatic adults for depression and suicide risk?
Bottom line
The USPSTF continues to conclude that current evidence is sufficient to support an overall moderate net benefit in screening for depression in asymptomatic adults, 19 years or older, including pregnant and postpartum persons (B recommendation). However, see the discussion in the Synopsis regarding the high rate of false-positive screening results. The task force further concludes that current evidence is not sufficient to assess the balance of benefits and harms of screening for suicide risk in the same population (I statement). This updated review is consistent with the 2016 USPSTF recommendation statement. 2c
Reference
Study design: Practice guideline
Funding: Government
Setting: Various (guideline)
Synopsis
The US Preventive Services Task Force (USPSTF) found adequate evidence that screening for depression in primary care results in improved health outcomes. Although evidence indicates that screening instruments can identify depression, a recent systematic review reported that more than 75% of positive scores on the Patient Health Questionnaire-9 will be falsely positive and the vast majority of true positives will be for patients with mild depression who will not benefit from treatment. The task force makes no recommendation on the frequency of screening for depression. Emphasis is again placed on the importance of further evaluation and treatment, if appropriate, for persons who screen positive. Only one randomized trial evaluated screening for suicide risk and found no difference in suicide ideation among those screened versus unscreened. In addition, evidence remains inadequate on the effectiveness of treatment for suicide risk.
Reviewer
David C. Slawson, MD
Professor and Vice Chair of Family Medicine for Education and Scholarship
Atrium Health
Professor of Family Medicine, UNC Chapel Hill
Charlotte, NC
Comments
Impact assessment
Excellent
Hard to recommend routine screening for depression and suici
What I thought before
Unrealistic to have GP do this. massively overwhelmed
Unrealistic to have GP do this. massively overwhelmed
SCRTEENIG IN DEPRESSED PREGNANT AND POSTPAURTUM PATIENTS
GOOD TO KNOW
New US screening recommendations will expose patients to unn
Spot on editorial on this recommendation: https://www.bmj.com/content/382/bmj.p1615
USPSTF 2023: Screening for depression recommended for adult
Since 75% of the positives are false positives, and the vast majority of true positives have mild depression which would not benefit from treatment, it seems that our time could be better spent on something other than screening for depression in adults.