Simon Gilbody1, Trevor Sheldon, Allan House. 1. Department of Health Sciences and Hull-York Medical School, University of York, United Kingdom. sg519@york.ac.uk
Abstract
BACKGROUND: Screening and case-finding has been proposed as a simple, quick and cheap method to improve the quality of care for depression. We sought to establish the effectiveness of screening in improving the recognition of depression, the management of depression and the outcomes of patients with depression. METHODS: We performed a Cochrane systematic review of randomized controlled trials conducted in nonmental health settings that included case-finding or screening instruments for depression. We conducted a meta-analysis and explored heterogeneity using meta-regression techniques. RESULTS: Sixteen studies with 7576 patients met our inclusion criteria. We found that the use of screening or case-finding instruments were associated with a modest increase in the recognition of depression by clinicians (relative risk [RR] 1.27, 95% confidence interval [CI] 1.02 to 1.59). Questionnaires, when administered to all patients and the results given to clinicians irrespective of baseline score, had no impact on recognition (RR 1.03, 95% CI 0.85 to 1.24). Screening or case finding increased the use of any intervention by a relative risk of 1.30 (95% CI 0.97 to 1.76). There was no evidence of influence on the prescription of antidepressant medications (RR 1.20, 95% CI 0.87 to 1.66). Seven studies provided data on outcomes of depression, and no evidence of an effect was found (standardized mean difference -0.02, 95% CI -0.25 to 0.20). INTERPRETATION: If used alone, case-finding or screening questionnaires for depression appear to have little or no impact on the detection and management of depression by clinicians. Recommendations to adopt screening strategies using standardized questionnaires without organizational enhancements are not justified.
BACKGROUND: Screening and case-finding has been proposed as a simple, quick and cheap method to improve the quality of care for depression. We sought to establish the effectiveness of screening in improving the recognition of depression, the management of depression and the outcomes of patients with depression. METHODS: We performed a Cochrane systematic review of randomized controlled trials conducted in nonmental health settings that included case-finding or screening instruments for depression. We conducted a meta-analysis and explored heterogeneity using meta-regression techniques. RESULTS: Sixteen studies with 7576 patients met our inclusion criteria. We found that the use of screening or case-finding instruments were associated with a modest increase in the recognition of depression by clinicians (relative risk [RR] 1.27, 95% confidence interval [CI] 1.02 to 1.59). Questionnaires, when administered to all patients and the results given to clinicians irrespective of baseline score, had no impact on recognition (RR 1.03, 95% CI 0.85 to 1.24). Screening or case finding increased the use of any intervention by a relative risk of 1.30 (95% CI 0.97 to 1.76). There was no evidence of influence on the prescription of antidepressant medications (RR 1.20, 95% CI 0.87 to 1.66). Seven studies provided data on outcomes of depression, and no evidence of an effect was found (standardized mean difference -0.02, 95% CI -0.25 to 0.20). INTERPRETATION: If used alone, case-finding or screening questionnaires for depression appear to have little or no impact on the detection and management of depression by clinicians. Recommendations to adopt screening strategies using standardized questionnaires without organizational enhancements are not justified.
Authors: Geoffrey Adams; Martin C Gulliford; Obioha C Ukoumunne; Sandra Eldridge; Susan Chinn; Michael J Campbell Journal: J Clin Epidemiol Date: 2004-08 Impact factor: 6.437
Authors: P S German; S Shapiro; E A Skinner; M Von Korff; L E Klein; R W Turner; M L Teitelbaum; J Burke; B J Burns Journal: JAMA Date: 1987 Jan 23-30 Impact factor: 56.272
Authors: Osvaldo P Almeida; Jane Pirkis; Ngaire Kerse; Moira Sim; Leon Flicker; John Snowdon; Brian Draper; Gerard Byrne; Robert Goldney; Nicola T Lautenschlager; Nigel Stocks; Helman Alfonso; Jon J Pfaff Journal: Ann Fam Med Date: 2012 Jul-Aug Impact factor: 5.166
Authors: Linda G Marc; Whitney R Henderson; Astrid Desrosiers; Marcia A Testa; Samuel E Jean; Eniko Edit Akom Journal: J Gen Intern Med Date: 2014-08-05 Impact factor: 5.128
Authors: Juan V Luciano; José L Ayuso-Mateos; Ana Fernandez; Jaume Aguado; Antoni Serrano-Blanco; Miquel Roca; Josep M Haro Journal: Qual Life Res Date: 2009-12-18 Impact factor: 4.147