NCBI Bookshelf. A service of the National Library of Medicine, National Institutes of Health.

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].

Show details

Appendix BUSPSTF Hierarchy of research design and quality rating criteria104

Hierarchy of Research Design


Properly conducted randomized controlled trial (RCT)


Well-designed controlled trial without randomization


Well-designed cohort or case-control analytic study


Multiple time series with or without the intervention; dramatic results from uncontrolled experiments


Opinions of respected authorities, based on clinical experience; descriptive studies or case reports; reports of expert committees

Design-Specific Criteria

Systematic Reviews


  • Comprehensiveness of sources considered/search strategy used
  • Standard appraisal of included studies
  • Validity of conclusions
  • Recency and relevance are especially important for systematic reviews

Case-Control Studies


  • Accurate ascertainment of cases
  • Nonbiased selection of cases/controls with exclusion criteria applied equally to both
  • Response rate
  • Diagnostic testing procedures applied equally to each group
  • Measurement of exposure accurate and applied equally to each group
  • Appropriate attention to potential confounding variables

Randomized Controlled Trials and Cohort Studies


  • Initial assembly of comparable groups
    • -for RCTs: adequate randomization, including first concealment and whether potential confounders were distributed equally among groups.
    • -for cohort studies: consideration of potential confounders with either restriction or measurement for adjustment in the analysis; consideration of inception cohorts
  • Maintenance of comparable groups (includes attrition, crossovers, adherence, contamination)
  • Important differential loss to follow-up or overall high loss to follow-up
  • Measurements: equal, reliable, and valid (includes masking of outcome assessment)
  • Clear definition of the interventions
  • All important outcomes considered

Diagnostic Accuracy Studies


  • Screening test relevant, available for primary care, adequately described
  • Study uses a credible reference standard, performed regardless of test results
  • Reference standard interpreted independently of screening test
  • Handles indeterminate result in a reasonable manner
  • Spectrum of patients included in study
  • Sample size
  • Administration of reliable screening test

Appendix B Table 1Specific Quality Rating Criteria

Randomized Controlled TrialsSystematic Reviews
Random assignmentIs there a clear review question?
Allocation concealmentWas the literature search strategy stated
Groups similar at baselineWere there explicit inclusion/exclusion criteria reported relating to selection of the primary studies
Eligibility criteria specifiedSelection Bias
Clear definition of InterventionIs there evidence of a substantial effort to search for all relevant research
Training of treatment providers reportedIs the validity of included studies adequately assessed
Supervision of treatment providers reportedIs sufficient detail of the individual studies presented
Patient and provider treatment allegiance or preference reportedAre any important studies missing
Blinded outcomes assessorsAre the primary studies summarized appropriately
Attrition <40% and not differentialWere the authors’ conclusions supported by the evidence they presented
Adherence reportedWhat was the funding source and role of funder
Cross-over reported
Likelihood of contamination
Appropriate statistical analysis


  • PubReader
  • Print View
  • Cite this Page
  • PDF version of this title (2.2M)

Recent Activity

Your browsing activity is empty.

Activity recording is turned off.

Turn recording back on

See more...