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O'Connor EA, Whitlock EP, Gaynes B, et al. Screening for Depression in Adults and Older Adults in Primary Care: An Updated Systematic Review [Internet]. Rockville (MD): Agency for Healthcare Research and Quality (US); 2009 Dec. (Evidence Syntheses, No. 75.)

Cover of Screening for Depression in Adults and Older Adults in Primary Care

Screening for Depression in Adults and Older Adults in Primary Care: An Updated Systematic Review [Internet].

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Appendix EPrevious Adult Depression Reviews

The 2002 USPSTF review took a broad approach to the evidence, considering trials that included both screening and additional support components to be relevant to the question of screening efficacy in addition to trials examining stand-alone screening programs. We have largely maintained this approach with some refinements in inclusion/exclusion criteria and in reporting. While the 2002 review included ten studies reporting health outcomes altogether, only five studies were also included in our review.10,109–112 Of the five excluded studies, two were excluded because they did not meet our a priori quality standards, including a minimum of 4-week followup.236,237 We excluded two other studies that did not use depression-specific screening instruments or report depression specific outcomes,238,239 and one study that screened a high-risk population rather than a general population.202

The 2005 Cochrane review on this topic included four studies: two that we also included (both studies of elderly populations with negative outcomes) and two that we excluded due to lack of depression-specific measures, both also with negative findings. The Cochrane review specifically excluded studies that they judged to have extensive quality improvement components on the logic that it would be impossible to disentangle the effects of the screening component from those of the other intervention components. The Cochrane reviewer has noted in another published article that the UK National Screening Guidelines require screening alone to improve outcomes before recommending its use.156 Thus, this approach is consistent with this requirement. Our conclusions are also consistent with this review’s conclusions in that we did not find support for screening programs in any adult age range without additional care support components.

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