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Screening for depression in adults

John Williams, MD
Jason Nieuwsma, PhD
Section Editors
Joann G Elmore, MD, MPH
Peter P Roy-Byrne, MD
Deputy Editor
Judith A Melin, MA, MD, FACP


Depression is the most common psychiatric disorder in the general population [1] 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 [8]. 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 [9].

Systematic screening carries the potential for substantial benefit. Untreated depression is associated with decreased quality of life [10], increased risk of suicide [11], and poor physiological outcomes when depression co-occurs with chronic medical conditions [12]. Compared with non-depressed persons, patients with depression have an increased risk of mortality (relative risk [RR] 1.81) [13]. Each year lived with depression has been calculated to detract approximately 20 to 40 percent from a quality-adjusted life year (QALY) [14-16]. Furthermore, depression entails a significant economic burden, accounting for billions of dollars in the United States alone each year [17]. The effects of depression extend beyond the individual patient, with negative impact on patients' employers [18], spouses [19,20], and children [21,22]. (See "Unipolar depression in adults: Assessment and diagnosis".)

This topic will review evidence of the effectiveness of screening adults and recommendations for screening for depression in primary care.

Depression screening in pregnant and postpartum women, new fathers, children and adolescents, older adults, and oncology patients is discussed in detail separately.

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Literature review current through: Nov 2017. | This topic last updated: Jun 01, 2017.
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