Screening for depression in adults
- John Williams, MD
John Williams, MD
- Professor of Medicine
- Duke University
- Jason Nieuwsma, PhD
Jason Nieuwsma, PhD
- Associate Professor of Psychiatry and Behavioral Science
- Duke University
- Section Editors
- Joann G Elmore, MD, MPH
Joann G Elmore, MD, MPH
- Editor-in-Chief — Primary Care (Adult)
- Section Editor — General Medicine
- Professor of Medicine, Adjunct Professor of Epidemiology
- University of Washington School of Medicine
- Peter P Roy-Byrne, MD
Peter P Roy-Byrne, MD
- Editor-in-Chief — Psychiatry
- Section Editor — Depressive Disorders
- Professor of Psychiatry and Behavioral Sciences
- University of Washington School of Medicine
Depression is the most common psychiatric disorder in the general population  and the most common mental health condition in patients seen in primary care [2-5]. Although symptoms of depression are prevalent among primary care patients, few patients discuss these symptoms directly with their primary care clinicians. Instead, two-thirds of primary care patients with depression present with somatic symptoms (eg, headache, back problems, or chronic pain), making detection of depression more difficult [6,7].
In the absence of screening, it is estimated that only 50 percent of patients with major depression are identified . Unless directly asked about their mood, patients omit information about depressive symptoms for a variety of reasons, including fear of stigmatization, belief that depression falls outside the purview of primary care, belief that depression isn't a "real" illness but rather a personal flaw, concerns about medical record confidentiality, and concerns about being prescribed antidepressant medication or being referred to a psychiatrist .
Untreated depression is associated with decreased quality of life , increased risk of suicide , and poor physiological outcomes when depression co-occurs with chronic medical conditions . Compared to non-depressed persons, patients with depression have an increased risk of mortality (relative risk 1.81) . Each year lived with depression has been calculated to detract approximately 20 to 40 percent from a quality adjusted life year [14-16]. Furthermore, depression entails a significant economic burden, accounting for billions of dollars in the United States alone each year . The effects of depression extend beyond the individual patient, with negative impact on patients' employers , spouses [19,20], and children [21,22]. (See "Unipolar depression in adults: Assessment and diagnosis".)
For these reasons, systematic screening carries the potential for substantial benefit. This topic will review the evidence of the effectiveness of screening and recommendations for screening for depression in primary care. Depression in pregnant and postpartum women, children and adolescents, and the management of patients with depression is discussed in detail separately. (See "Postpartum unipolar major depression: Epidemiology, clinical features, assessment, and diagnosis" and "Unipolar major depression during pregnancy: Epidemiology, clinical features, assessment, and diagnosis" and "Screening tests in children and adolescents" and "Unipolar major depression in adults: Choosing initial treatment" and "Unipolar depression in adults: Treatment of resistant depression" and "Unipolar depression in adults: Management of highly resistant (refractory) depression".)
Depressive syndromes are defined in DSM-5 . The term "major depression" in this topic refers to unipolar depression.
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- EPIDEMIOLOGY AND RISK FACTORS
- PRESENTATION, NATURAL HISTORY, AND COURSE OF ILLNESS
- RATIONALE FOR SCREENING
- EFFECTIVENESS OF SCREENING
- SCREENING OPTIONS
- Targeted versus general population screening
- Screening instruments
- - PHQ-9
- - PHQ-2
- - Beck Depression Inventory for Primary Care
- - WHO-5
- - Instruments for special populations
- SCREENING IMPLEMENTATION
- GUIDELINE RECOMMENDATIONS
- United States
- United Kingdom
- SUMMARY AND RECOMMENDATIONS