Routine screening for depression questioned

Routine screening for depression by primary care doctors may not be cost effective. In fact, a recent study from the Canadian Medical Association Journal, asserts that these routine tests may drain resources away from the people who have been diagnosed with depression and other mental illness.

Screening is recommended in Canada and the United States. The United Kingdom does not recommend screening because there is actually a lack of data supporting its effectiveness. The UK’s National Institute for Health and Clinical Excellence guidelines cited concerns about high rates of false-positives, lack of data supporting any benefit, the high cost and large amount of resources needed for screening and the diversion of resource away from people with known, serious depression.

“The prevalence of depression and the availability of easy-to-use screening instruments make it tempting to endorse widespread screening for the disease,” writes Dr. Brett Thombs, Associate Professor, Department of Psychiatry, McGill University. “However, screening in primary care is a resource-intensive endeavor, does not yet show evidence of benefit and would have unintended negative effects for some patients.”

Screening is beneficial when it identifies people with untreated condition that will respond to treatment. Mild depression usually resolves without intervention and it is the screening and identification of this type of depression that may waste resources.

The study recommends consistent treatment of depression for people who have recurring episodes rather than rescreening to see if the depression has returned.

“Given the lack of evidence of benefit from screening and the concerns that we have described, it is not reasonable to simply assume that depression screening is a good policy,” the authors concluded. So while they are not willing to go out there and say it’s a process that should end, they question the continued use and believe more scrutiny of the use of resources is warranted.

Source: CMAJ, Medical NewsToday