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Screening and case finding instruments for depression.

S Gilbody1, A O House, T A Sheldon

  • 1Department of Health Sciences, University of York, York, UK YO10 5DD. sg519@york.ac.uk

The Cochrane Database of Systematic Reviews
|October 20, 2005
PubMed
Summary
This summary is machine-generated.

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Routine depression screening and case finding instruments show minimal impact on detection, management, or outcomes in primary care. A two-stage screening approach may be effective but requires further large-scale trials.

Area of Science:

  • Clinical effectiveness research
  • Health services research
  • Mental health screening

Background:

  • Screening and case finding instruments are advocated for improving depression detection and management in non-specialist settings.
  • Evidence for the clinical and cost-effectiveness of these strategies is crucial for adoption.
  • This review assesses the impact of screening tools on depression recognition, management, and outcomes.

Purpose of the Study:

  • To determine the clinical and cost-effectiveness of depression screening and case finding instruments.
  • To evaluate their impact on depression recognition, management, and patient outcomes.

Main Methods:

  • Systematic review of randomized controlled trials (RCTs) from multiple databases (Cochrane Library, EMBASE, MEDLINE, etc.) up to 2004.

Related Experiment Videos

  • Included RCTs involved depression screening/case finding instruments with clinician feedback in non-mental health settings.
  • Excluded studies using screening alongside enhanced care like case management.

    • Main Results:

    • Routine screening showed a borderline impact on depression recognition (RR 1.38) but substantial heterogeneity. A two-stage selective screening approach showed potential effectiveness (RR 2.66).
    • A trend towards higher intervention rates was observed with feedback (RR 1.35), but this was influenced by one study and heterogeneity was significant.
    • Few studies reported on depression outcomes, with three of four showing no clinical effect at 6 or 12 months. Cost-effectiveness was not evaluated.

    Conclusions:

    • Routinely administered depression screening/case finding instruments have minimal impact on detection, management, or outcomes.
    • Practice guidelines recommending isolated screening strategies should be resisted.
    • A two-stage screening procedure warrants further evaluation in large-scale trials with economic assessments.