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Pignone M, Gaynes BN, Rushton JL, et al. Screening for Depression [Internet]. Rockville (MD): Agency for Healthcare Research and Quality (US); 2002 Apr. (Systematic Evidence Reviews, No. 6.)

  • This publication is provided for historical reference only and the information may be out of date.

This publication is provided for historical reference only and the information may be out of date.

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Screening for Depression [Internet].

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2Methods

This chapter of the SER documents the procedures that the RTI-UNC Evidence-based Practice Center (EPC) used to develop this report on screening for depression among adults and children. We document the literature search (eg, inclusion and exclusion criteria, relevant Medical Subject Headings [MeSH terms]) and briefly describe the procedures followed in abstracting data from included articles, developing evidence tables, analyzing the literature, and subjecting the draft to a robust peer review process.

In all these steps, EPC staff collaborated with 2 members of the USPSTF who acted as liaisons for this topic; they are co-authors of the SER. This collaboration took place chiefly by e-mail and numerous conference calls. Steps in the development of this SER were presented at USPSTF meetings in May and September 1999 and February 2000, where the EPC staff, USPSTF liaisons, and the full Task Force were able to discuss the analytic framework and key questions, literature search strategy, results, and implications of the findings.

Literature Search Strategy

To identify articles relevant to the questions of screening and treatment of depression, the EPC staff searched the MEDLINE database from 1994 to 1999 and used recent systematic reviews. We supplemented these sources by searching the Cochrane database on depression, neurosis, and anxiety disorders; conducting additional specific MEDLINE searches from 1966 to 1994; and hand-searching bibliographies of systematic reviews, relevant original articles, the second edition of the Guide to Clinical Preventive Services, 31 and the 1993 Clinical Practice Guideline on Depression from the Agency for Health Care Policy and Research (now the Agency for Healthcare Research and Quality). 3

Inclusion/Exclusion Criteria

We prospectively established eligibility criteria for all searches. Table 3 presents these criteria. We restricted the search to articles published in English and excluded nonpublished studies, those published in abstract form only, letters, and editorials.

Table 3. Depression: Inclusion and Exclusion Criteria.

Table

Table 3. Depression: Inclusion and Exclusion Criteria.

Diagnosis articles were identified by searching for studies with information about diagnostic accuracy, particularly sensitivity and specificity. We included only those articles that compared the screening instrument with a criterion standard. For articles on therapy, we restricted the search to randomized controlled trials (RCTs) and meta-analyses of RCTs. For articles on direct effects of screening and feedback, we included randomized trials and before-and-after studies of identification, treatment, or health outcomes.

We also used the second edition of the USPSTF Guide to Clinical Preventive Services, 31 as well as systematic reviews, meta-analyses, and evidence-based practice guidelines that addressed screening and treatment of depression, to identify key articles that appeared earlier than the 1994 or 1995 period. Finally, we reviewed the bibliographies of included articles to detect any important articles that may have been missed at other steps. Table 4 documents the results of the 2 main literature searches.

Table 4. Screening for Depression: Search Strategy Results.

Table

Table 4. Screening for Depression: Search Strategy Results.

Literature Reviewed

Two EPC staff independently reviewed the titles and abstracts of the articles identified by the literature searches and excluded ones on which they agreed that eligibility criteria were not met. When the initial reviewers disagreed, the articles were carried forward to the next review stage in which the EPC team members reviewed the full articles and made a final decision about inclusion or exclusion. Table 5 summarizes the results of the literature searches and reviews of abstracts.

Table 5. Screening for Depression: Summary Results from Literature Searches and Reviews.

Table

Table 5. Screening for Depression: Summary Results from Literature Searches and Reviews.

Literature Synthesis and Preparation Of Systematic Evidence Review

Data Abstraction and Development of Evidence Tables

Reviewers entered study design and outcomes data from the articles on screening accuracy, screening outcomes, and treatment onto paper abstraction forms. These data were used to construct evidence tables.

To characterize the quality of the included studies, the internal and external validity for each article were rated in the evidence tables using criteria developed by the USPSTF Methods Work Group. Apart from grading individual articles, we also rated the aggregate internal validity and external validity as well as the coherence (agreement of the results of the individual studies) for each of the key questions in the analytic framework. Appendix C presents the Work Group's detailed criteria for grading individual articles and rating aggregate validity and consistency of the articles reviewed.

In addition to these general criteria, we developed specific guidelines for this report. In diagnostic accuracy studies, we required that the studies had performed verification of screening results against an accepted criterion standard. Studies in which no criterion standard was used were excluded from this report. Studies that reported the results for only the portion of the sample that received the criterion standard were considered to have potential for spectrum bias and were also rated "fair."

For treatment studies, the failure to report results by intention-to-treat led to a grade of "fair" if the difference in sample size at the beginning and end of the trial was greater than 20% overall or if the drop-out rate was significantly different between the intervention and control groups.

Screening outcomes studies were included if they examined the impact of screening and feedback versus usual care on the diagnosis, treatment, or outcomes of depression.

Peer Review Process

We conducted a broad-based, external review of the draft SER. Outside reviewers were representatives of key primary care professional associations that have formal liaison ties to the USPSTF, a representative of the Canadian Task Force on Preventive Health Care, representatives of other professional societies, clinical experts in the area of depression, staff of the Agency for Healthcare Research and Quality, and representatives of other relevant federal agencies. Appendix A lists the names and affiliations of all peer reviewers.

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