CHAPEL HILL -- Screening people for depression during regular primary care visits to doctors can improve recovery from that debilitating illness if systems are in place to assure accurate diagnosis, effective treatment and follow-up, a new University of North Carolina at Chapel Hill and Research Triangle Institute study concludes.

The research, conducted for the U.S. Preventive Services Task Force, involved reviewing and combining data from all relevant studies found on the subject between 1994 and August 2001. Results appear in the May 21 issue of Annals of Internal Medicine, a medical journal, and coincide with release of a task force recommendation that screening for depression be done during doctor visits.

"This work is part of a larger literature review we did at the UNC-RTI Evidence-Based Practice Center about screening for depression," said study leader Dr. Michael Pignone, assistant professor of medicine at the UNC School of Medicine. "Here we specifically focused on whether screening changes the rate of detection and treatment and improves outcomes for depressed patients seen in primary care."

From the studies they examined and analyzed, researchers concluded that between 7 percent and 10 percent more depressed patients were no longer depressed six months after screening and treatment, said Pignone, a fellow at UNC's Cecil G. Sheps Center for Health Services Research.

"Since depression affects up to 10 percent of patients seen in primary care, the medical community would have to screen about 100 people to produce one additional remission," he said. "That still represents hundreds of thousands of people in this country alone who are suffering unnecessarily, and so we think it is worth doing. Major depression in particular is an extremely debilitating, disruptive illness that makes life feel like it's not worth living."

The study, which is known as a meta-analysis, involved calculating and combining rates at which depression is detected and treated and the rate at which screening produces remission of depressive symptoms, Pignone said. It is important because of considerable controversy over whether screening for depression in primary care settings is useful.

Some experts have supported the practice, while others said it was not possible to do well during regular office visits, he said. Still others have said that primary care physicians would not know what to do with the information once they got it. Some maintain that screening would be useful but only if followed by the right kind of treatment program.

"Initial screening for depression is pretty straight forward and not complicated since it can be done by asking just two questions," Pignone said. "Are you currently sad or depressed, and are the things that previously brought you pleasure no longer bringing you pleasure? If a patient answers 'yes' to either one, then there's another five- to 10-minute interview with more specific questions."

Such screening works best when doctors have a system in place in their offices to ensure that people diagnosed with major depression receive effective treatment and follow-up, he said.

Co-authors of the new research report include Drs. Bradley N. Gaines, assistant professor of psychiatry at UNC; Tracy Orleans, a scientist with the Robert Wood Johnson Foundation; Cynthia Mulrow, professor of medicine at the University of Texas at San Antonio; Kathleen N. Lohr, senior scientist at the Research Triangle Institute and head of the Evidence-Based Practice Center; and Jerry L. Rushton, assistant professor of pediatrics at the University of Michigan. Orleans and Mulrow also are members of the U.S. Preventive Services Task Force.

Like the other 11 AHRQ Evidence-based Practice Centers in the United States and Canada, the RTI-UNC team reviews all relevant information on health topics to provide guidance for medical decisions. The U.S. Department of Health and Human Services' Agency for Healthcare Research and Quality supports the UNC and RTI work.

RTI is an independent, nonprofit research organization dedicated to improving health and other human concerns. More information is available on RTI at http://www.rti.org/epc and on the U.S. Preventive Services Task Force at http://www.preventiveservices.ahrq.gov.

---University of North Carolina at Chapel Hill

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