CTFPHC says there is a lack of evidence on the effectiveness of screening in adults with no apparent symptoms of depression
Ottawa, 13 May, 2013–The Canadian Task Force on Preventive Health Care (CTFPHC) today released an updated guideline on screening for depression in primary care settings. Due to a lack of high quality evidence on the benefits and harms of screening, the new guideline recommends not routinely screening adults who show no apparent symptoms of depression. The guideline is published in the Canadian Medical Association Journal.
The guideline updates the previous guideline on screening for depression published by the CTFPHC in 2005, and is based on a comprehensive evidence synthesis and a broad consultation process that included 13 key stakeholder organizations. Given the lack of direct evidence available on the benefits and harms of screening individuals with no apparent symptoms of depression, concerns remain about the potential harms, including false positive diagnoses with subsequent unnecessary treatment.
“There is a lack of high quality research demonstrating the benefits and harms of screening in adults with no apparent symptoms of depression,” said Dr. Michel Joffres, member of the CTFPHC and chair of the depression guideline working group. “Without evidence that screening is beneficial for patients with no apparent symptoms of depression, and considering the potential harms, we recommend not to routinely screen for depression in primary care settings—either in patients at average risk, or those with characteristics that may increase their risk for depression.”
The current recommendation to not routinely screen adults with no apparent symptoms of depression is a change from the previous CTFPHC recommendations. The 2005 CTFPHC guideline recommended screening adults from the general population in primary care settings where integrated staff assisted systems were available to manage treatment.
“Given the change in the guideline, we are recommending that clinicians be alert to the clinical symptoms of depression, especially in individuals with characteristics that may increase their risk for depression,” explained Dr. Gabriela Lewin, member of the CTFPHC working group. “It is important to note that these recommendations do not apply to people with known depression, with past history of depression, or people in treatment for depression. It is also important to note that patients presenting with symptoms or other clues to the presence of depression should be appropriately assessed for depression.”
The main recommendations of the Guideline include:
- Recommendations on screening for depression are provided for adults (18 years of age or older) who present at a primary care setting with no apparent symptoms of depression. These recommendations do not apply to people with known depression, with past history of depression, or people in treatment for depression.
- For adults at average risk for depression the CTFPHC recommends not routinely screening for depression (Weak recommendation; very-low-quality evidence)
- For adults in subgroups of the population who may be at increased risk of depression the CTFPHC recommends not routinely screening for depression (Weak recommendation; very-low-quality evidence)
- The CTFPHC recommends that high quality randomized controlled trials with unscreened controls, evaluating the effect of screening for depression, be a high priority, especially in populations with a higher baseline prevalence of depression. Future clinical trials should also report on the potential harms of screening—including false positive diagnoses with subsequent unnecessary treatment.
For the complete report and details of the recommendations, please visit the Screening for Depression Guideline.
About the Canadian Task Force on Preventive Health Care
The Canadian Task Force on Preventive Health Care has been established to develop clinical practice guidelines that support primary care providers in delivering preventive health care. The mandate of the ctfphcis to develop and disseminate clinical practice guidelines for primary and preventive care, based on systematic analysis of scientific evidence.