Is the United States Preventive Services Task Force still a voice of caution?

Lenzer, Jeanne

doi:10.1136/bmj.j743

Cited by 10 publications

(16 citation statements)

References 15 publications

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“…The USPSTF was recently criticized for relying upon indirect evidence and for not adequately considering potential harms in recommending depression screening [ 44 ]. Experts pointed out that there are numerous examples where the use of insufficient and indirect evidence has led to ineffective and harmful screening programs and argued that guideline makers should refrain from recommending new screening services based on only indirect evidence [ 44 ]. In the context of questionnaire-based screening programs, this concern is heightened because, when RCTs have directly tested these programs, they have not found evidence of health benefits.…”

Section: Discussionmentioning

confidence: 99%

Consistency and sources of divergence in recommendations on screening with questionnaires for presently experienced health problems or symptoms: a comparison of recommendations from the Canadian Task Force on Preventive Health Care, UK National Screening Committee, and US Preventive Services Task Force

Thombs

Saadat

Riehm

et al. 2017

BMC Med

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BackgroundRecently, health screening recommendations have gone beyond screening for early-stage, asymptomatic disease to include “screening” for presently experienced health problems and symptoms using self-report questionnaires. We examined recommendations from three major national guideline organizations to determine the consistency of recommendations, identify sources of divergent recommendations, and determine if guideline organizations have identified any direct randomized controlled trial (RCT) evidence for the effectiveness of questionnaire-based screening.MethodsWe reviewed recommendation statements listed by the Canadian Task Force on Preventive Health Care (CTFPHC), the United Kingdom National Screening Committee (UKNSC), and the United States Preventive Services Task Force (USPSTF) as of 5 September 2016. Eligible recommendations focused on using self-report questionnaires to identify patients with presently experienced health problems or symptoms. Within each recommendation and accompanying evidence review we identified screening RCTs.ResultsWe identified 22 separate recommendations on questionnaire-based screening, including three CTFPHC recommendations against screening, eight UKNSC recommendations against screening, four USPSTF recommendations in favor of screening (alcohol misuse, adolescent depression, adult depression, intimate partner violence), and seven USPSTF recommendations that did not recommend for or against screening. In the four cases where the USPSTF recommended screening, either the CTFPHC, the UKNSC, or both recommended against. When recommendations diverged, the USPSTF expressed confidence in benefits based on indirect evidence, evaluated potential harms as minimal, and did not consider cost or resource use. CTFPHC and UKNSC recommendations against screening, on the other hand, focused on the lack of direct evidence of benefit and raised concerns about harms to patients and resource use. Of six RCTs that directly evaluated screening interventions, five did not report any statistically significant primary or secondary health outcomes in favor of screening, and one trial reported equivocal results.ConclusionsOnly the USPSTF has made any recommendations for screening with questionnaires for presently experienced problems or symptoms. The CTFPHC and UKNSC recommended against screening in all of their recommendations. Differences in recommendations appear to reflect differences in willingness to assume benefit from indirect evidence and different approaches to assessing possible harms and resource consumption. There were no examples in any recommendations of RCTs with direct evidence of improved health outcomes.

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Section: Discussionmentioning

confidence: 99%

Consistency and sources of divergence in recommendations on screening with questionnaires for presently experienced health problems or symptoms: a comparison of recommendations from the Canadian Task Force on Preventive Health Care, UK National Screening Committee, and US Preventive Services Task Force

Thombs

Saadat

Riehm

et al. 2017

BMC Med

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“…The USPSTF was recently criticized by experts for the uncritical use of indirect evidence and for not adequately considering potential harms in recommending depression screening [19]. When high-quality trials are feasibly conducted, as is the case with depression screening, calls for screening should be based on direct evidence from RCTs of screening programs.…”

Section: Resultsmentioning

confidence: 99%

Primary care doctors should not screen their patients for depression

Thombs

Ziegelstein

2017

Expert Review of Neurotherapeutics

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“…Despite the lack of evidence to support it, in 2016, the USPSTF reaffirmed their 2009 recommendation for screening adolescents age 12 and over (31,32). In the 2016 update, the identification of specific ADMs and specific therapeutic interventions as well as the following cautionary statement were removed: "However, because of risk of suicidality SSRIs should be considered only if clinical monitoring is possible" [US Preventive Services Task Force, 2009 (33), p. 1224].…”

Section: Depression Screening In Adolescents: Is There Evidence Of Bementioning

confidence: 99%

“…However, when health care policy (e.g., USTSPF recommendation for screening youth) starts to look too much like an advertisement for cherished beliefs, we cannot claim to be engaging in evidence-based practice [see, e.g., (36)]. Moreover, routine depression screening may have the unintended effect of overtreatment with antidepressants and could deflect limited healthcare resources away from those who need it most (2,18,31,(37)(38)(39). Research demonstrates that a stepped approach is best: treating mild-moderate depression with an antidepressant has been found to be no better than watchful waiting (40,41).…”

Section: Depression Screening In Adolescents: Is There Evidence Of Bementioning

confidence: 99%

Drivers of and Solutions for the Overuse of Antidepressant Medication in Pediatric Populations

et al. 2020

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Children in the United States and internationally are increasingly being diagnosed with depression and related psychiatric conditions and a recent study found that antidepressant (ADM) use in children and adolescents rose substantially in youth cohorts in five Western countries from 2005 to 2012. However, there has been ongoing controversy over the effectiveness and safety of ADM use in children, including concerns about ADM increasing suicidality and self-harm. In addition to the increase in the diagnosis of depression, commercially driven off-label prescriptions have been cited as a significant reason for high rates of pediatric ADM prescribing. In this commentary, we discuss two drivers of the overuse of ADM, both of which are products of an increasingly medicalized approach to mental health: 1) the demand for mental health and depression screening in youth, despite the lack of evidence to support it, and 2) the renewed momentum of the Global Mental Health Movement and concomitant calls to "scale up" the diagnosis and treatment of mental illness. Using the lens of institutional corruption, we identify the ways in which both guild and financial conflicts of interest create obstacles to rational prescribing practices in pediatric populations and offer suggestions for reform.

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Is the United States Preventive Services Task Force still a voice of caution?

Cited by 10 publications

References 15 publications

Primary care doctors should not screen their patients for depression

Drivers of and Solutions for the Overuse of Antidepressant Medication in Pediatric Populations

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