Panel Recommends Depression Screening For Pregnant And Postpartum Women


(Reuters Health) - U.S. adults should be screened for depression, says an influential panel of government-backed experts.

Screening for depression can ultimately help reduce or stop depression symptoms from coming back, lessen other healthcare needs and improve the health of pregnant or postpartum women with depression, according to the U.S. Preventive Services Task Force (USPSTF).

After reviewing previous studies, the panel found that "if you just wait for patients to say they're depressed, you miss a significant number of people who are depressed and would benefit from treatment," said Dr. Michael Pignone, a USPSTF member and professor at the University of North Carolina at Chapel Hill.

Major depressive disorder is the leading cause of disability among adults in high-income countries, according to the USPSTF. The cost of treating depression in the U.S. reached nearly $23 billion in 2009, and lost productivity from the condition likely cost the nation an estimated $23 billion in 2011.

The recommendation published Tuesday in the Journal of the American Medical Association is an update to the panel's 2009 recommendation that supported depression screening for adults if their doctors' offices were capable of providing quality care, or among selected patients even if that care were not available.

"We really just tried to have clearer language," Pignone told Reuters Health.

The panel now says everyone age 18 or older should be screened for depression with adequate systems in place to ensure accurate diagnosis, effective treatment and appropriate follow-up.

"If you're going to screen, you need to do it well," said Pignone.

While the USPSTF doesn't endorse a specific screening method or define how often people should be screened, Pignone said it could be as simple as answering two questions on a form before a patient goes in to see their doctor.

"There is no reason why you can't do the screening right there (in the waiting room) on an iPad," said Keith Humphreys, a professor of psychiatry and behavioral sciences at Stanford Health Care in California.

Humphreys, who was not involved with crafting the new recommendations, told Reuters Health he approves of them.

"The reality of American healthcare is that mental health has to be done in primary care," he said.

Pignone said the potential harms from depression screening are minimal. Also, numerous treatment options are available, which means side effects can often be overcome by switching to another treatment.

"There is always another treatment option available that doesn't have those effects," he said. Those treatments include medication, psychotherapy, cognitive behavioral therapy (CBT) and even simple observation.

The panel's evidence review showed antidepressant drugs and psychotherapy can be quite effective for the average adult with depression. Other studies showed CBT to be effective among pregnant and postpartum women, which the USPSTF highlights as a group especially in need of screening.

"That could be quite beneficial," said Humphreys of pregnant and postpartum women. "That's a population that does have a high rate of depression that's generally treatable."

Other organizations like the American Academy of Pediatrics and the American College of Obstetricians and Gynecologists recommend some sort of depression screening for pregnantor postpartum women. The American Academy of Family Physicians also endorses screening for all adults.