Helping doctors know when to screen for depression
Posted by Raquel Maurier on May 13, 2013
(Edmonton) A national task force led by a University of Alberta researcher is encouraging physicians in Canada to stop conducting routine screening for depression because there’s no evidence the practice is beneficial. And the pitfall of regular screening could be an incorrect diagnosis of depression, which would lead to unneeded treatment and unnecessary labelling for the patient.
The Canadian Task Force on Preventive Health Care published its findings today in the peer-reviewed Canadian Medical Association Journal. The task force is led by Marcello Tonelli, a Canada Research Chair in the Department of Medicine and the School of Public Health at the U of A.
“If patients have no apparent symptoms, there’s no need to screen for depression—we don’t need to go looking for it,” says Tonelli.
“But we are advising doctors that if they see patients with symptoms that suggest depression might be present, such as not making eye contact or noting they are having trouble sleeping, physicians should be alert to that and ask more questions to determine whether depression is the underlying cause—especially in circumstances where patients come in for a different matter and start volunteering information that indicates they may suffer from depression.”
Tonelli noted these guidelines aren’t for patients who are already diagnosed with or being treated for depression, or who have personal histories of depression. The guidelines are aimed at helping physicians deal with patients who have no symptoms of depression, including those in high-risk groups who show no symptoms. Patients considered at higher risk for developing depression include those who have experienced traumatic events, those who struggle with substance abuse or chronic health issues, Aboriginal patients, those with family history of depression, and women who are perinatal or postpartum.
A 2002 study noted one in every eight Canadian adults will experience a major depression at some point in their life. Productivity losses stemming from depression amount to $4.5 billion a year across the country.
Tonelli explained the guideline was revisited because the last recommendation was made in 2005 and needed to be updated, and physicians across the country said they wanted more guidance on the important topic of screening for depression. The 2005 recommendation suggested screening adults in integrated medical settings where various health-care practitioners could help patients manage their treatment, with regular followup.
Tonelli and his colleagues who worked on this guideline reviewed research studies from around the world over the course of a year.
“The major finding from our careful and detailed look for evidence is that there was very little evidence either way. We didn’t find a lot of evidence that screening for depression is effective, and we didn’t find a lot of evidence that screening isn’t effective.”
And if time doesn’t need to be spent on screening a patient who has no symptoms of depression, Tonelli says, “it will free up time for physicians to do an even better job of detecting depression in those who are crying out for help, and treating patients who have been diagnosed with depression and who may be currently undertreated.
“We know there is still room to improve care for those who are receiving treatment for depression, and that’s where we think the emphasis should be placed. We are trying to make sure doctors use their time in a way that is most effective for both themselves and their patients. Physicians really wanted guidance on this topic, and we hope these guidelines will provide that guidance.”
The systematic review was funded by a grant from the Canadian Institutes of Health Research; the guideline production was funded by the Public Health Agency of Canada.