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Screening for depression in general adult population

Screening for depression in general adult population

Last Reviewed : 12/30/2020
Screening for depression in general adult population

Depression is one of the leading causes of disability in individuals above 15 years. It affects both men and women. Increasing incidence is observed in teens these days. It is common in pregnant and postpartum women, which also affects her child. It is crucial to speak about it and diagnose it as it affects families, work, business, and society. It is a common diagnosis in patients seeking care in primary healthcare centers.

 

Risk Factors

Several risk factors are associated with depression. These risk factors are sex, age, ethnicity, geographic location education, marital status, and employment status. All these are the few risk factors that determine the incidence and prevalence of depression. Women, young and middle-aged adults of nonwhite ethnicity (uneducated, divorced, and unemployed) have shown higher rates of depression. Other risk factors are a chronic medical condition, a family history of psychiatric disorder, and a history of other mental health illnesses.

Risk factors for depression in the elderly include loneliness, sleep disorder, complicated grief, disability, poor medical health, and history of depression in the past. In a similar vein, depression in pregnant and postpartum women include risk factors of prenatal anxiety, life stress, child care stress, poor self-esteem, decreased social support, single parenting, low socioeconomic status, unintended pregnancy, a history of depression in the past or postpartum depression in the previous pregnancy.

The U.S. Preventive Services Task Force (USPSTF) makes recommendations on the effectiveness of specific screening of disease in individuals with risk factors but no related signs and symptoms based on the balance between harm and benefits of the screening. And the USPSTF found adequate evidence that screening individuals with depression improve the accurate identification of it in primary care settings, including pregnant and postpartum women with depression. This recommendation of USPSTF applies to adults of 18 years or older. For children and adolescents, a separate statement recommendation is given by the USPSTF.
 

Screening Techniques and Treatment

There are numerous depression screening methods used. The most common ones are Patient Healthcare Questionnaire of various forms, Geriatric Depression scale in elderly, Hospital Anxiety and Depression Scales in adults, and the Edinburgh Postnatal Depression Scale in pregnant and postpartum women. Positive results from these screening should be assessed additionally for the severity of depression and other comorbid psychological or medical conditions. There is no optimal timing or optimum interval for screening depression. A realistic approach would be to screen all adults who were not screened previously. Afterward, use clinical judgment (based on the risk factors, the presence of other comorbid conditions, and life events) to determine if additional screening is required. Treatment of depression includes antidepressants, psychotherapy like cognitive behavioral therapy (CBT), or both. Due to the side effects and teratogenicity associated with antidepressants, clinicians are advised to use CBT or other evidence-based counseling interventions in pregnant and breastfeeding women.

The USPSTF has found convincing evidence that depression screening with an adequate support system improves clinical outcomes in adults, including pregnant and postpartum women. The Task Force found compelling evidence that screening of depression and treating it with antidepressants, psychotherapy, or both have significantly reduced the clinical morbidity. They also found adequate evidence that the treatment of depression with CBT has improved clinical outcomes in pregnant and postpartum women.
 

Conclusion

The USPSTF found that the magnitude of harms of screening for depression in adults and treating it with CBT in pregnant and postpartum women is small to none. However, the USPSTF found that the 2nd generation antidepressants are associated with harms like increased suicidal behavior and increased risk of GI bleed. But the magnitude of these risks is small. The USPSTF concludes that the magnitude of harm is too small to moderate.

To conclude, the Task Force recommends screening of depression in the general adult population, including pregnant and postpartum women. Also, screening should be implemented with adequate systems in place to ensure accurate diagnosis, effective treatment, and appropriate follow-up.

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