The Canadian Task Force on Preventive Health Care agrees with other investigative bodies which have concluded that using a questionnaire to screen adults for depression has no clear benefit for patients’ health.
A new guideline issued by the Canadian Task Force on Preventive Health Care recommends against using questionnaires in primary care settings for routine depression screening of adults because of the “very low-certainty evidence” supporting the practice. The Task Force was established by the Public Health Agency of Canada to develop guidelines to assist primary care providers in delivering preventive health care.
In determining whether adults with no symptoms of depression should be routinely screened for depression by means of questionnaires administered during primary care visits, the Canadian Task Force commissioned a systematic review of recent medical literature on benefits and harms of the practice.
In screening questionnaires, number values are assigned to the responses to the questions, which result in an overall score that determines whether the individual is considered “screen positive” and then referred for further evaluation and potential treatment.
A clear benefit from routine depression screening of adults could not be established by the Task Force, which concluded that evidence from the reviewed research studies “provided very uncertain results or showed little to no difference” between those screened and those who were not. No studies were identified that reported on the potential harms of screening, including false-positive results, overdiagnosis, and overtreatment, which can wrongly lead to the prescribing of antidepressants and the waste of medical resources.
The Task Force’s conclusion: “We recommend against screening all adults aged 18 years and older for depression using questionnaires (strong recommendation, very low-certainty evidence), based on evidence suggesting that depression screening using a screening tool [questionnaire] has little to no effect on health.” The recommendation was published in the Canadian Medical Association journal, the CMAJ.
Such “strong recommendations” are issued by the Task Force “when the undesirable effects outweigh the desirable effects.” The current recommendation applies to adults with no depressive symptoms – even those considered to be at an elevated risk of depression.
The Canadian guidance is consistent with the recommendations of the National Institute for Health and Care Excellence in England and the United Kingdom National Screening Committee, which do not recommend routine screening of adults for depression.
While the Canadian Task Force is advising against the screening because research studies indicated “very low-certainty evidence” to support it, the U.S. Preventive Services Task Force (USPSTF) looked at the research and decided in 2023 to recommend screening, based on what it claimed is a “moderate certainty that screening for depression has a moderate net benefit.” Even so, it advised health care providers to consider individual patient circumstances, such as an absence of any sign that the individual is depressed, before deciding whether to screen.
Stephanie Collier, MD, MPH, director of education in geriatric psychiatry at McLean Hospital and an instructor in psychiatry at Harvard Medical School, disagrees with the USPSTF decision.
“Primary care clinicians routinely screen their patients for depression based on the USPSTF guidelines. However, screening patients is resource-intensive and should be reconsidered. The benefits of screening for depression still have not been proven, whereas the harms of screening are known,” she wrote on the Insights website of Harvard Medical School.
Research raising doubts about the validity of depression screening questionnaires includes a 2023 study, reported in the British medical journal BMJ, which found that a widely used screening questionnaire, the so-called PHQ-9, identifies 2.5 times as many cases of major depression as a clinical interview does.
STAT, an online health and medicine news outlet, conducted its own investigation in 2023 and concluded that “data suggesting that PHQ-9 has actually improved outcomes [for patients] is ambiguous at best.”
“STAT’s investigation shows how this simple tool has become a crutch – used in place of, rather than as a gateway to, thoughtful mental health care,” it reported.
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