Screening for depression in general practice and related medical settings

OBJECTIVE: To determine if screening in general practice and related medical settings improves management and clinical outcomes in people with depression. DATA SOURCES: The Medline (1966-2002), EMBASE (1980-2002) and PsycINFO (1966-2002) databases were searched. These were supplemented by searching the Cochrane databases (to 2002); performing additional specific searches on Medline, EMBASE and PsycINFO; scrutinising reference lists of selected articles; and querying experts. STUDY SELECTION: Inclusion criteria were: review of prospective studies with a primary focus of depression screening in general practice settings; review of studies of healthy populations or people with known depression; publication in a peer-reviewed journal; and written in English. Eleven reviews that satisfied these criteria were assessed for quality using the Oxman and Guyatt Index. Four reviews met the criterion of a score of five or more. DATA EXTRACTION: One author tabulated relevant material (including number and type of studies, outcomes/endpoints, measures of association/statistical results, and findings) from the four key reviews. A second author independently checked the accuracy of this extracted material. DATA SYNTHESIS: Brief self-report instruments have acceptable psychometric properties and are practical for use in general practice settings. Screening increases the recognition and diagnosis of depression and, when integrated with a commitment to provide coordinated and prompt follow-up of diagnosis and treatment, clinical outcomes are improved. CONCLUSIONS: Although controversial, the evidence is now in favour of the appropriate use of screening tools in primary care.