All American adults should be screened for depression as part of their normal health-care routine, an influential panel recommended on Tuesday. The U.S. Preventive Services Task Force also singled out maternal mental illness for the first time by suggesting that women be screened during pregnancy and after childbirth.
The new guidelines, updated for the first time since 2009 and published in the journal JAMA, are a recognition of the devastating toll mental illness is taking around the world. Researchers have noted a surge in diagnoses in recent years related to the stress of modern life and fears of terrorism, violence and poverty. The World Health Organization recently predicted mental illness would jump from the fifth leading cause of death and disability to second place by 2020.
The task force, an independent body appointed by the Department of Health and Human Services, noted that major depressive disorder is associated with suicide and impaired ability to manage other health issues. An estimated $22.8 billion was spent on depression treatment in 2009, it said, and lost productivity cost an additional estimated $23 billion in 2011.
“Depression has a major effect on quality of life for the patient and affects family members, especially children,” the group noted in its report.
Screening for depression typically involves starting with a series of questions about individuals’ feelings about their lives. Examples include asking them the extent to which these types of statements are true: “I can laugh and see the funny side of things,” “I feel as if I am slowed down,” or “I look forward with enjoyment to things.”
If these initial screening tests show elevated risk for depression, providers are asked to conduct additional assessments to look for other issues such as anxiety panic attacks, substance abuse or other medical conditions.
“In the United States, like many other economically developed nations, primary-care practices represent the best place for implementation of these methods, because it is the only venue where both screening and, if clinically indicated, treatment can be provided,” Michael E. Thase, a professor of psychiatry at the University of Pennsylvania, wrote in an editorial accompanying the publication of the guidelines.
The report recommends screening each adult at least once, but it notes that the “optimal frequency of such screening has not been established.”
Thase suggested “for patients in generally good health who only see their primary care physicians sporadically, it may make sense to screen at each visit” and possibly to “incorporate periodic web-based ‘health checks.’”
The guidelines also go into significant detail about the risks for women during and after pregnancy— underscoring new research about just how big an effect postpartum depression can have on the well-being of a mother and her child. Risk factors listed for maternal depression include poor self-esteem, child-care stress, prenatal anxiety, life stress, decreased social support, single relationship status, history of depression, difficult infant temperament, lower socioeconomic status and unintended pregnancy.
The task force gave the recommendations a grade of B based on how much clinical evidence there is to support their findings, a rating that should provide coverage for the screenings under the Affordable Care Act.