The US Preventive Services Task Force found good evidence that screening improves the accurate identification of depressed patients in primary care settings and that treatment of depressed adults identified in primary care settings decreases clinical morbidity. Trials that have directly evaluated the effect of screening on clinical outcomes have shown mixed results.Small benefits have been observed in studies that simply feed back screening results to clinicians. Larger benefits have been observed in studies in which the communication of screening results is coordinated with effective followup and treatment. The USPSTF concluded the benefits of screening are likely to outweigh any potential harms.
What to look for in a depressed patient
For a number of reasons, patients most likely will not come out and say that they are depressed. Instead, they will present with complaints such as these:
When looking for these symptoms, listen for certain key phrases that will also tip you off:
Screening toolsUSPSTF recommends a number of screening tests including:
"'Asking two simple questions about mood and anhedonia ('Over the past 2 weeks, have you felt down, depressed, or hopeless?' and "Over the past 2 weeks, have you felt little interest or pleasure in doing things?') may be as effective as using longer instruments."
If you want to be a bit less clinical, ask questions such as these:
Depression, of course increases a person’s risk of taking their life. A number of factors can contribute to this, including:
When it comes to a patient’s risk of taking their own life, there are two more things to which you should give special consideration:
Prior expiration attempts
Of their previous expiration attempts, always ask the patient whether they intended to leave the world. This will give you better insight into how suspicious you should be of expiration risk in future episodes of depression.
Ways and means
When discussing a expiration attempt, have the patient get very specific about what they intend to do. If the patient claims to be committed to jumping off the top of the highest mountain on Catalina Island, but they have no means to get there, that’s a far less alarming situation than that of an old man who lives alone, drinks, and owns a handgun.