A Ten-Year Review of the Validity and Clinical Utility of Depression Screening

OBJECTIVE: Use of depression screening instruments in primary care is controversial. The authors reviewed research studies published since the development of national practice guidelines to determine whether new evidence might favor screening. The review focused on evidence-related validity and clinical utility of depression screening instruments. METHODS: Silver Platter MEDLINE was searched for English-language studies of depression screening instruments published between 1986 and 1995. Studies were classified by type--reviews of studies, outcome studies, validation studies. RESULTS AND CONCLUSIONS: Fifty-nine studies met criteria for review. Validation studies were the most frequent type (39 studies) and were subclassified according to population, type of comparison, and analytical method. These studies documented the validity of screening instruments compared with formal criteria and demonstrated consistently better performance for systematic approaches compared with clinical impressions. Thirteen studies were reviews; those reviewing evidence for effectiveness disagreed in their conclusions. Only seven outcome studies related to depression screening instruments were found, and none showed measurable benefit in a screened population. Several studies showed that very brief instruments performed about as well as longer, well-validated questionnaires for screening in general populations.