Unveiling the Value of Early Depression Screening in U.S. Adults: A Systematic Review of Clinical Benefits and...

Major depressive disorder (MDD) in U.S. adults is common, disabling, and costly. Screening is recommended when follow-up is available, yet uptake remains uneven, and digital tools raise governance risks.

To synthesize U.S. evidence on depression burden, screening uptake, and test performance, and the clinical and economic value of early detection linked to structured follow-up, including digital and AI-based approaches.

Systematic review guided by PRISMA 2020 (2000 through March 2025) across four databases and U.S. reports; dual screening and descriptive synthesis using predefined inclusion criteria and standardized extraction templates were conducted independently.

From 3,224 records, 112 studies were included. Depression prevalence reached 8.3 percent in adults and over 20 percent in young adults by 2022. While primary care screening rates vary (48 to 60 percent), PHQ-9 performance remains robust (88 percent sensitivity and specificity). Linking screening to collaborative care doubled remission rates (from 18 to 40 percent), cut hospitalizations by 20 percent, and reduced missed workdays from 9 to 4. Economically, integrated care is highly efficient (ICER: 15,000 to 35,000 dollars per QALY) with a 5 to 1 ROI in older adults. Digital tools reduce costs but face over 40 percent attrition; passive sensing shows high accuracy (0.89) but remains limited by privacy concerns.

Value concentrates where systems deliver timely follow-up, treatment initiation, and monitoring; screening without capacity yields limited benefit. Limitations include heterogeneous comparators, model dependence on adherence and fidelity, and privacy, bias, and equity risks for digital tools.

Standardize PHQ 2 then PHQ 9 workflows with EHR and portal automation, clear follow-up timelines, and stepped-care escalation.

Tie incentives to screening plus documented follow-up, support under-served settings, and require privacy and bias-monitoring standards for digital screening.

Run pragmatic payer-specific evaluations and head-to-head cost-utility comparisons of digital versus questionnaire-based screening with longer follow-up and equity endpoints.