Screening for depression in primary care: what do we still need to know?

Depress Anxiety. 2004;19(3):137-45. doi: 10.1002/da.20000.


The United States Preventive Services Task Force (USPSTF) recently issued the recommendation that primary care physicians screen adult patients for depression. A policy to screen primary care patients for depression has appeal as a strategy to reduce the personal and societal costs of undiagnosed and untreated depression. Such appeal may be justified if the evidence supports the screening policy in three areas: effectiveness, cost-effectiveness, and feasibility. The USPSTF recommendation leaves many issues in each of these areas unresolved and physicians are left the choice of two important program characteristics: screening instrument and screening interval. We discuss how uncertainties in the screening protocol and treatment process affect whether screening is an effective and cost-effective use of resources with respect to other health interventions. We suggest that targeting screening to groups at a higher risk for depression may lead to a more effective use of health care resources. A screening program may not be feasible even if effectiveness and cost-effectiveness are optimized. We discuss uncertainties in the USPSTF recommendation that affect the feasibility of implementing such a program in physicians' practices.

Publication types

  • Review

MeSH terms

  • Adult
  • Cost-Benefit Analysis
  • Depression / diagnosis*
  • Depression / economics
  • Depression / epidemiology
  • Feasibility Studies
  • Humans
  • Mass Screening* / economics
  • Practice Patterns, Physicians'*
  • Prevalence
  • Primary Health Care* / economics
  • Psychiatric Status Rating Scales
  • Psychometrics
  • Surveys and Questionnaires
  • United States / epidemiology