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Open Access Research article

There are no randomized controlled trials that support the United States Preventive Services Task Force guideline on screening for depression in primary care: a systematic review

Brett D Thombs1234567*, Roy C Ziegelstein8, Michelle Roseman7, Lorie A Kloda9 and John PA Ioannidis101112

Author Affiliations

1 Department of Psychiatry, McGill University, Montréal, Québec, Canada

2 Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montréal, Québec, Canada

3 Department of Medicine, McGill University, Montréal, Québec, Canada

4 Department of Psychology, McGill University, Montréal, Québec, Canada

5 Department of Educational and Counselling Psychology, McGill University, Montréal, Québec, Canada

6 School of Nursing, McGill University, Montréal, Québec, Canada

7 Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, Québec, Canada

8 Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, USA

9 Library, McGill University, Montréal, QC, Canada

10 Stanford Prevention Research Center, Department of Medicine, Stanford University School of Humanities and Sciences, Stanford, CA, USA

11 Department of Health Research and Policy, Stanford School of Medicine, Stanford University School of Humanities and Sciences, Stanford, CA, USA

12 Department of Statistics, Stanford University School of Humanities and Sciences, Stanford, CA, USA

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BMC Medicine 2014, 12:13  doi:10.1186/1741-7015-12-13

Published: 28 January 2014

Abstract

Background

The United States Preventive Services Task Force (USPSTF) recommends screening adults for depression in primary care settings when staff-assisted depression management programs are available. This recommendation, however, is based on evidence from depression management programs conducted with patients already identified as depressed, even though screening is intended to identify depressed patients not already recognized or treated. The objective of this systematic review was to evaluate whether there is evidence from randomized controlled trials (RCTs) that depression screening benefits patients in primary care, using an explicit definition of screening.

Methods

We re-evaluated RCTs included in the 2009 USPSTF evidence review on depression screening, including only trials that compared depression outcomes between screened and non-screened patients and met the following three criteria: determined patient eligibility and randomized prior to screening; excluded patients already diagnosed with a recent episode of depression or already being treated for depression; and provided the same level of depression treatment services to patients identified as depressed in the screening and non-screening trial arms. We also reviewed studies included in a recent Cochrane systematic review, but not the USPSTF review; conducted a focused search to update the USPSTF review; and reviewed trial registries.

Results

Of the nine RCTs included in the USPSTF review, four fulfilled none of three criteria for a test of depression screening, four fulfilled one of three criteria, and one fulfilled two of three criteria. There were two additional RCTs included only in the Cochrane review, and each fulfilled one of three criteria. No eligible RCTs were found via the updated review.

Conclusions

The USPSTF recommendation to screen adults for depression in primary care settings when staff-assisted depression management programs are available is not supported by evidence from any RCTs that are directly relevant to the recommendation. The USPSTF should re-evaluate this recommendation.

Please see related article: http://www.biomedcentral.com/1741-7015/12/14 webcite

Registration

PROSPERO (#CRD42013004276)

Keywords:
Depression; Primary care; Screening; Systematic review