Dr. Martin also agree with you and USPSTF recommendations. But recent evidence cast doubt on the actual usefulness of carrying out routine screening. For example the Canadian Task Force on Preventive Health Care: “Recommend not routinely screening adults at average risk in primary care settings. Recommend not routinely screening subgroups of the population in primary care settings who have characteristics that may increase their risk of depression (e.g., people with a family history of depression or with chronic health problems)”.

So I find it very interesting the thought of other colleagues on this issue… thank you very much

www.cmaj.ca/lookup/doi/10.1503/cmaj.130634

Ont Health Technol Assess Ser. 2013; 13(8): 1–45.

Screening and Management of Depression for Adults With Chronic Diseases

An Evidence-Based Analysis is a paper that reviewed studies that looked at screening and treating for depression in people with chronic diseases. The conclusion stated: " In people with diabetes, treatment of depression did not affect clinical measures of diabetes management. In people with heart failure and coronary artery disease, treatment of depression did not improve heart failure management or reduce rates of heart attacks or death. At present, there is no evidence that screening and treating for depression improves the symptoms of chronic diseases or lead to use of fewer health care services."

The first question one has to ask is: what actually constitutes depression. In my experience most people who state to be depressed are actually struggling to deal with an issue, i.e. "acopia", and results in fluctuations in mood whilst searching for solutions. These types of emotional experiences fall within the realm of normal variability, even if they last for a few days or weeks. Solving the problem invariably results in the resolution of the mood instability. This has nothing to do with the classical melancholic depression, does not require to be screened for and even less to be managed with drugs of questionable efficacy but high levels of side effects, including suicide and homicide. 

You must keep in mind that a screening intervention allow us to detect hidden cases of depression, but at same time can produce an amount of false positives that may lead to a overdiagnosis and overtreatment.

Are you ready to rule out with accuracy a great amount of false positives?

And, are you ready to deliver appropiate treatment and follow-up to the identified depressed patients?

However, if you limit the screening to a selected target of patients (i. e., those with chronic organic diseases, those with previous depression, or those with other risk signs or factors) as you increase the pre-test probabilities, you will improve the performance of the screening test.

Article Systematic depression screening in high-risk patients attend...

Keep in mind that not all the patients with major depression criteria will achieve benefits of an active treatment: those with mild 'major depression' are better managed with a watchful waiting strategy.

I am agree about the importance of screening. But, I also know that this is an important question: screening x not screening .

Dr Alex Mitchell present a great debate about this topic. And I know that he has published many article about that. Maybe you can find important informations and materials in his website.

Please, take a look, he is an amazing clinician-researcher. He works with cancer patients, but also published in primary care: depression, schizophrenia, anxiety...

You can also find his slides - debate about screening vs not screening

http://www.psycho-oncology.info

In pulmonology practice (treatment and monitoring of COPD) as in clinical addictology (management of smoking or alcohol cessation, etc.) it is essential to systematically detect depressive disorders.

The appropriate management of these disorders determine compliance to treatment, efficacy of treatment and management, quality of life during the treatment.

We can detect these disorders with simple scales; the best known are the Hospital Anxiety Depression test and the Beck Depression Inventory.

Regards. Jean. 

This is a great question. A few years ago psychiatrists were asked a related question: Is depression over-diagnosed? Responses from two leading psychiatrists in Australia were 'yes'... and 'no'.

Here are the two contrasting responses in the BMJ:

http://www.ncbi.nlm.nih.gov/pubmed/17703040

http://www.ncbi.nlm.nih.gov/pubmed/17703041

A more recent review by Lichtman and colleagues argue that depression should be elevated as a risk factor for poor prognosis in patients with coronary heart disease. Their conclusion was as follows:

"the preponderance of evidence supports the recommendation that the American Heart Association should elevate depression to the status of a risk factor for adverse medical outcomes in patients with acute coronary syndrome."

suggesting that depression 'should' be routinely screened for in this cohort at least.

Ref: Lichtman, J. H., Froelicher, E. S., Blumenthal, J. A., Carney, R. M., Doering, L. V., Frasure-Smith, N., et al. (2014). Depression as a risk factor for poor prognosis among patients with acute coronary syndrome: systematic review and recommendations: a scientific statement from the american heart association. Circulation, 129(12), 1350–1369. doi:10.1161/CIR.0000000000000019

Depression should be screened routinely in primary care especially for those suffering from chronic conditions like diabetes, cardiovascular diseases, cancers and other diseases. Simple and easy tools are available that primary care physicians and trained nurses can use such as patient health questionnaire-9 (PHQ-9).

There are numerous ways of screening NOT diagnosing depression or any psychiatric disorder in a primary care population (PRIME-MD, PHQ-9). However, little effort has been taken to Identify depression amongst the population at the community level by using pre-existing screening tools and then confirming with DSM-IV.

 Hence you could screen for mental disorders but you need to confirm it with the DSM-IV/V criteria.

One could design a new screening tool but it might be far too laboriousand time consuming - it requires validation and reliability testing. It would be a good idea to intention was to find out if there is a method to just diagnose or uncover hidden depression cases at primary care using pre-existing screening/diagnostic tool.

 Hope this helps.

In my opinion, it's very important to identify depression in many studies; this must constitute bias in many resarch works; if it's not evaluate... and depression is very often present in several diseases (particularly chronic diseases and it affects quality of life, smoking or alcoohol cessations, control of weight, evolution of COPD, observance of medications, etc.) Many possibility of scales to use are possible: Hospital Anxiety Depression scale, Beck Depression Inventory, VAS,VNS, etc.

In my opinion, depression is almost like a cough: it accompanies many medical conditions (both traditionally conceived and psychological) and depression screens could thus be an important initial screening tool. Additionally, many of the well-established tools have been adapted to, and tested in, numerous languages.

In my clinical experience, patients with neurological disorders of almost any kind will benefit from counseling for coping strategies, whether they are formally diagnosed with depression or not, and regardless of whether they're taking anti-depressants (which are also a valuable tool).  I think screening is an excellent idea.  I would add that many people with neurological illnesses are suffering from grief, whether or not it is formally classified as depression.  Patients may be grieving the loss of independence, status, employment, relationships -- the life they knew before their diagnosis.  My subjective observation is that patients who do not find strategies for coping with their loss, will not do as well therapeutically.  So I would say "yes" to screening, but I wouldn't stop there.  Counseling would be a beneficial part of treatment for anyone suffering from a neurological illness, even if criteria for a diagnosis of depression is not met and medications are not necessary..

Dear colleagues: Here I send some updates. I hope you find it useful and enrich scientific debate. Best regards...

Update of the 2009 US Preventive Services Task Force (USPSTF) recommendation on screening for depression in adults. 

Recommendation The USPSTF recommends screening for depression in the general adult population, including pregnant and postpartum women. Screening should be implemented with adequate systems in place to ensure accurate diagnosis, effective treatment, and appropriate follow-up. (B recommendation)

http://jama.jamanetwork.com/article.aspx?articleid=2484345#SummaryofRecommendationandEvidence

Yes, we should actively, routinely perform comprehensive mental health screenings to identify mental illnesses early, and they should be a part of the annual physical process. An active role in screening is required as there are many barriers that prevent patients from recognizing and seeking assessment, from undiagnosed problems with introspection, to alexithymic manifestations of depression, to cultural barriers that prevent proper internal analysis and acknowledgment of their own mental issues, and even plain ignorance regarding the field of psychology and mental health.

This becomes all the more pressing for people with speech-language, neurodevelopmental, and intellectual disabilities and disorders, as they struggle to process and express that they are suffering and desire aid (in those cases, the tools from DM-ID-2 and other NADD publications is needed for accuracy).