Routine screening for depression not recommended for adults with no apparent symptoms of depression

May 13, 2013, Canadian Medical Association Journal

For adults with no apparent symptoms of depression, routine screening is not recommended in primary care settings because of the lack of high-quality evidence on the benefits and harms of screening for depression, according to new evidence-based guidelines from the Canadian Task Force on Preventive Health Care (CTFPHC) published in CMAJ (Canadian Medical Association Journal).

These guidelines mark a change in approach from the task force's 2005 guidelines, which recommended screening adults in primary care settings where there were integrated staff-assisted systems to manage treatment.

"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, either in adults at average risk or in those with characteristics that may increase their risk of depression," writes Dr. Michael Joffres, chair of the CTFPHC's depression guideline writing group and member of the Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, with coauthors.

The recommendations do not apply to people with known depression, with a history of depression or who are receiving treatment for depression.

Key recommendations:

  • No in primary care settings for adults at average risk of depression.
  • No routine screening in settings for adults in subgroups of the population who may be at increased risk of depression, including people with a family history of depression, as a child, recent , chronic health issues, substance abuse, perinatal and postpartum status, or Aboriginal origin.

However, clinicians should be alert to the possibility of depression, especially in patients with characteristics that may increase their risk of depression, and should look for it when there are clinical clues, such as insomnia, low mood, anhedonia (inability to experience pleasure) and .

Guidelines in other countries differ slightly from the Canadian guidelines. The US Preventive Services Task Force recommends universal screening where supports exist to ensure follow-up treatment. In the United Kingdom, the National Institutes for Health and Clinical Excellence recommends a targeted approach, focusing on people with a history of depression rather than general screening.

These recommendations do not apply to people with known depression, with a history of depression or who are receiving treatment for depression.

"These recommendations do not apply to people with known depression, with a history of depression or who are receiving treatment for depression. Patients who present with symptoms or other clues to the presence of depression should be appropriately assessed for depression," explained Dr. Gabriela Lewin, member of the CTFPHC working group.

The task force calls for high-quality randomized controlled trials with an unscreened control group to understand the effect of screening, the potential harms of screening, such as false-positive diagnoses with subsequent unnecessary treatment, as well as the implications of earlier detection of depression through .

In a related commentary, Dr. Roger Bland, Department of Psychiatry, University of Alberta, and coauthor write, "There is no question, as the task force amply illustrates, that depression constitutes a major public health problem. Although milder cases may require only watchful waiting rather than treatment, about 15% of people with major depression go on to a chronic course, with much residual disability. Family physicians have been criticized for failing to recognize depression. However, studies have shown that many missed cases are those of milder depression, which often remits spontaneously, and that patients with milder forms of depression may experience adverse effects and other complications if the is treated."

Explore further: Routine screening for depression not recommended

More information: In addition to the full guidelines, a decision support tool and frequently asked questions for clinicians are available on the task force's website:


Related Stories

Routine screening for depression not recommended

September 19, 2011
Routine screening for depression in primary care patients has not been shown to be beneficial or an effective use of scarce health care resources, which would be better focused on providing more consistent treatment of people ...

No benefit from screening all patients for suicide risk, report says

April 23, 2013
(HealthDay)—After completing a review of existing research, an expert panel has determined that there is not enough evidence to recommend that all teens and adults be screened for suicide risk factors.

Over-diagnosis and over-treatment of depression is common in the US

April 30, 2013
Americans are over-diagnosed and over-treated for depression, according to a new study conducted at the Johns Hopkins Bloomberg School of Public Health. The study examines adults with clinician-identified depression and individuals ...

Depression stigma may be fading: survey

October 11, 2012
(HealthDay)—Most Americans know what depression is and believe there is no shame in seeking treatment for the mental health condition, a new survey shows.

Risk of depression influenced by quality of relationships, research says

April 30, 2013
The mantra that quality is more important than quantity is true when considering how social relationships influence depression, say U-M researchers in a new study.

Screening for post-stroke depression inadequate and inconsistent, study finds

October 1, 2012
Physicians are prescribing anti-depressants for stroke patients without first giving them a proper diagnosis, they are over-treating some patients, and overlooking others, according to a study presented today at the Canadian ...

Recommended for you

Inherited IQ can increase in early childhood

January 18, 2018
When it comes to intelligence, environment and education matter – more than we think.

Modulating molecules: Study shows oxytocin helps the brain to modulate social signals

January 17, 2018
Between sights, sounds, smells and other senses, the brain is flooded with stimuli on a moment-to-moment basis. How can it sort through the flood of information to decide what is important and what can be relegated to the ...

Baby brains help infants figure it out before they try it out

January 17, 2018
Babies often amaze their parents when they seemingly learn new skills overnight—how to walk, for example. But their brains were probably prepping for those tasks long before their first steps occurred, according to researchers.

Reducing sessions of trauma-focused psychotherapy does not affect effectiveness

January 17, 2018
Posttraumatic Stress Disorder (PTSD) patients treated with as few as five sessions of trauma-focused psychotherapy find it equally effective as receiving 12 sessions.

How past intentions influence generosity toward the future

January 17, 2018
Over time, it really is the thought that counts – provided we know what that thought was, suggests new research from Duke University's Fuqua School of Business.

Tracking the impact of early abuse and neglect

January 17, 2018
Children who experience abuse and neglect early in life are more likely to have problems in social relationships and underachieve academically as adults.


Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.