Depression Screening in Primary Care: Why the Canadian Task Force on Preventive Health Care Did the Right Thing

Abstract

Objective: To review the recent recommendation against routinely screening adults for depression in primary care settings by the Canadian Task Force on Preventive Health Care (CTFPHC). Methods: We reviewed the CTFPHC recommendation and discussed it in the context of relevant evidence. Results: Depression screening, which involves using depression symptom questionnaires to attempt to identify patients who have unrecognized depression, was previously recommended by the CTFPHC in primary care settings with staff-assisted depression care programs in place to ensure accurate diagnosis, effective treatment, and follow-up, but not in the absence of such programs. The CTFPHC recently updated this guideline and recommended against routinely screening adults for depression in primary care because there have not been any randomized controlled trials (RCTs) that have shown depression screening to be beneficial and because of a concern about the potentially high number of false-positive screens that would occur. Without evidence from RCTs of better health outcomes from screening, there are numerous factors that suggest that depression screening, even with collaborative depression care, may not be beneficial for patients, including the high rate of patients already treated, uncertainty about the ability of depression screening tools to accurately identify previously unrecognized patients, and relatively small treatment effects among patients with less severe depression who would be most likely to be identified through screening. Routine screening would expose some patients to avoidable risks and would pose a significant cost burden. Conclusion: The CTFPHC recommendation to not screen for depression in primary care is consistent with available evidence. Clinicians in primary care settings should be alert to signs of depression and attend to symptoms through assessment and, as appropriate, referral or management, as recommended by the CTFPHC.