Screening for depression in general practice and related medical settings

Abstract

Objective: To determine if screening in general practice and related medical settings improves management and clinical outcomes in people with depression. Data sources: The Medline (1966–2002), EMBASE (1980–2002) and PsycINFO (1966–2002) databases were searched. These were supplemented by searching the Cochrane databases (to 2002); performing additional specific searches on Medline, EMBASE and PsycINFO; scrutinising reference lists of selected articles; and querying experts. Study selection: Inclusion criteria were: review of prospective studies with a primary focus of depression screening in general practice settings; review of studies of healthy populations or people with known depression; publication in a peer‐reviewed journal; and written in English. Eleven reviews that satisfied these criteria were assessed for quality using the Oxman and Guyatt Index. Four reviews met the criterion of a score of five or more. Data extraction: One author tabulated relevant material (including number and type of studies, outcomes/endpoints, measures of association/statistical results, and findings) from the four key reviews. A second author independently checked the accuracy of this extracted material. Data synthesis: Brief self‐report instruments have acceptable psychometric properties and are practical for use in general practice settings. Screening increases the recognition and diagnosis of depression and, when integrated with a commitment to provide coordinated and prompt follow‐up of diagnosis and treatment, clinical outcomes are improved. Conclusions: Although controversial, the evidence is now in favour of the appropriate use of screening tools in primary care.

A mobile phone application for the assessment and management of youth mental health problems in primary care: health service outcomes from a randomised controlled trial of mobiletype

“…Assisting GPs in the assessment and management of youth mental health problems is critical [4,12], and the mobiletype program via its design offers a solution to a number of the doctor and patient barriers in detecting and managing mental health. mobiletype is systematic in assessment, time-efficient, provides detailed mental and general health information, generally well-received by patients [14], low-cost, and uses a communication technology that crosses traditional geographic and socioeconomic barriers.…”

“…In addition to improving the rate of detection of mental health symptoms, systematic measures increase a sense of partnership between patient and clinician, empower the patient to take control of their health, reduce feelings of helplessness and encourage patients to recognise early warning signs of relapse and to seek earlier intervention for future episodes [11,12]. Despite this need, GPs have only a limited amount of time to spend with their patients, with most appointments in Australia lasting only 15 minutes [13].…”

Ethical complexities of screening for depression and intimate partner violence (IPV) in intervention studies

“…The view that routine and universal screening is a simple, quick and cheap method to improve the quality of care for depression [16] may provide an attractive solution for governments to curtail projected increases in disease burden [17]. Emerging evidence suggests that screening for PND does not represent value for money predominantly due to additional costs of managing women incorrectly diagnosed as depressed (false positive scores) [18].…”

“…Further considerations about using screening for recruitment in an intervention relate to whether screening tools provide accurate and efficient identification of potential risk or cases because of the detection of false positives and false negatives [17]. There is uncertainty around identifying the most suitable tool, given that for IPV alone there are more than 33 tools available to measure abuse [10].…”

“…There is uncertainty around identifying the most suitable tool, given that for IPV alone there are more than 33 tools available to measure abuse [10]. Studies also need to consider who will administer screening tools and interpret results [17]. Indeed, some question if ‘screening’ is the appropriate term to use in IPV research since the complex and hidden nature of IPV belies the pre-symptomatic disease states for which screening tools are generally designed [10].…”