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Meta-Analysis
. 2008 Apr 8;178(8):997-1003.
doi: 10.1503/cmaj.070281.

Screening and case-finding instruments for depression: a meta-analysis

Simon Gilbody  1 , Trevor Sheldon, Allan House
Affiliations
Meta-Analysis

Screening and case-finding instruments for depression: a meta-analysis

Simon Gilbody et al. CMAJ. .

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.

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Figures

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Figure 1: Quality of Reporting of Meta-analysis (QUOROM) flow chart showing the number of studies screened and included in the meta-analysis.
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Figure 2: Effect of screening and case-finding instruments on the recognition of depression by clinicians, by method of patient selection.
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Figure 3: Effect of screening and case-finding instruments on the management of depression by clinicians, by method of patient selection.
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Figure 4: Effect of screening and case-finding instruments on the outcome of depression at follow-up.
See this image and copyright information in PMC

Comment in

References

    1. Agency for Health Care Policy Research. Depression in primary care. Washington: US Department of Health and Human Services, 1993.
    1. Simon GE, Von Korff M. Recognition and management of depression in primary care. Arch Fam Med 1995;4:99-105. - PubMed
    1. Katon W, Ciechanowski P. Impact of major depression on chronic medical illness. J Psychosom Res 2002;53:859-63. - PubMed
    1. MacMillan HL, Patterson CJS, Wathen CN; The Canadian Task Force on Preventive Health Care. Screening for depression in primary care: recommendation statement from the Canadian Task Force on Preventive Health Care. CMAJ 2005;172:33-5. - PMC - PubMed
    1. Agency for Healthcare Research and Quality. Screening for Depression: Systematic Evidence Review Number 6. Rockville (MD): The Agency; 2002.

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