No More Over Screening for Depression

Depression screenings in primary care settings may harm unless symptoms are present

/ Author:  / Reviewed by: Chris Galloway, M.D.

(RxWiki News) It may seem counterintuitive, but screenings for depression in at-risk adults could harm more than help. Screening folks without risk or with obvious symptoms may be best.

Recently, the Canadian Task Force on Preventive Health Care updated the current guidelines for screening for depression in primary care settings.

The update recommended primary care providers keep an eye out for symptoms associated with depression, but to only screen for depression in adults with no history of, or risk factors for, depression.

"Tell MD about insomnia, low mood or thoughts of suicide."

A research team from the Canadian Task Force on Preventive Health Care, led by Michel Joffres, MD, PhD, from the Faculty of Health Sciences at Simon Fraser University in Canada, investigated screening for depression in adults in primary care settings. The results of this study were intended to replace the 2005 Canadian Task Force guidelines.

Depression can lower a person’s quality of life and increase the risk of suicide, long-term physical conditions and hospital admissions. Fortunately, there are medications and therapies to treat and manage depressive symptoms.

The US Preventive Services Task Force recommends primary care providers that can help patients access mental health medications and therapies should screen all adults for depression.

The UK National Institutes for Health and Clinical Excellence recommends primary care providers look screen for depression in people that may be at high risk for depression. Risk factors for depression include chronic health problems, women just after giving birth, having a history of depression, traumatic childhood or substance abuse.

The Canadian Task Force has not adopted a policy for screening all patients for depression due to the potential for diagnosing people with depression that did not actually have depression. A false diagnosis could lead to unnecessary medications, which could have side effects, and being labeled with a social stigma that can be associated with depression.

For this study, the researchers set out to design the new Canadian guidelines for screening for depression in a primary care setting.

Based on clinical experience and reviewing multiple studies, the researchers recommended not routinely screening for depression in adults with an average or increased risk for depression.

The researchers could find no clear benefit for screening for depression in adults with an average or increased risk for depression. The researchers were also unable to clearly outline the potential harms to screening for depression in primary care settings.

The Canadian Task Force recommended that primary care providers screen for depression in people 18 years of age and older with no history of depression, no symptoms of depression or risk for depression.

The researchers did recommend that health care providers keep an eye out for clinical symptoms for depression (e.g., insomnia, low mood and suicidal thoughts), in which case a referral for treatment may be in order.

The study authors said that better information is needed about the accuracy of depression screening tools and the best ways to screen for depression in primary care settings.

“In the absence of a demonstrated benefit of screening, and in consideration of the potential harms, we recommend not routinely screening for depression in primary care settings, wither in adults at average risk or in those with characteristics that may increase their risk of depression,” said the study authors.

“However, clinicians should be alert to the possibility of depression, especially in patients with characteristics that may increase their risk of depression,” the study authors continued.

This study was published in May in the Canadian Medical Association Journal.

The Public Health Agency of Canada and the Canadian Institutes of Health Research supported funding for this project. No conflicts of interest were found. 

Reviewed by: 
Review Date: 
May 13, 2013
Last Updated:
September 19, 2013