The estimated prevalence of depressive disorders is 13–22% in primary care clinics but is only recognized in approximately 50% of cases.
The US Preventative Services Task Force (USPSTF) recommendations were updated in 2016. The USPSTF published a level B recommendation for screening for depression in the general adult population (18 years and older), including older patients and pregnant and postpartum women. Screening should be implemented with adequate systems in place to ensure accurate diagnosis, effective treatment, and appropriate follow-up.
Use of patient-administered screening tools has increased as a quick and reliable option in the first step of depression assessment or as a treatment monitor.
An initial screen must be followed by a clinical interview to make the diagnosis of depression. The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) criteria for major depression are reviewed below.
Diagnostic criteria for major depressive disorder (DSM-5)
At least 5 of the following symptoms have been present during the same 2-week period, represent a change from previous functioning, and include either depressed mood or loss of interest or pleasure.
Marked diminished interest or pleasure
Significant weight loss or weight gain
Insomnia or hypersomnia
Psychomotor agitation or retardation
Fatigue or loss of energy
Feelings of worthlessness or excessive guilt
Diminished ability to concentrate
Recurrent thoughts of death or suicidal ideation
A 2002 literature review found that median sensitivity across 16 instruments, including the BDI, CES-D, SDS, and GDS, for major depression was 85%, ranging from 50% to 97%, while median specificity was 74%, ranging from 51% to 98%.
The more common screening tools will be reviewed in this topic, including the following:
Hamilton Depression Rating Scale (HDRS)
Beck Depression Inventory (BDI)
Patient Health Questionnaire (PHQ)
Major Depression Inventory (MDI)
Center for Epidemiologic Studies Depression Scale (CES-D)
Zung Self-Rating Depression Scale (SDS)
Geriatric Depression Scale (GDS)
Cornell Scale for Depression in Dementia (CSDD)