Depression Screening Tools for Primary Care

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Prevalence of depression in the US has increased nearly 3-fold since before COVID-19. Here, a primer on the best assessment tools for depression diagnosis in primary care.

Primary care doctors are often the first health care provider patients see when they are dealing with symptoms of depression. Research has shown that the prevalence of depressive symptoms has increased during the coronavirus disease 2019 (COVID-19) pandemic and may be 3-times higher than before COVID-19 emerged. What are some useful tools you can use to screen for depression in your patients? Scroll through the quick slideshow below for more.

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Depression in adults. The USPSTF1 and AAFP2 recommend screening for depression in adults aged >18 years when systems are in place to ensure accurate diagnosis, effective treatment, and appropriate follow-up.

  • PHQ-2: 2-item Patient Health Screening Questionnaire (accepted as initial screening tool in all age groups4,5). If positive, follow-up with PHQ-9 or clinical review
  • PHQ-9: 9-item Patient Health Screening Questionnaire3,5
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Depression in teenagers. The USPSTF recommends screening all teenagers aged 12-18 years for depression in primary care when systems are in place to ensure accurate diagnosis, effective treatment, and appropriate follow-up.6 The most widely used depression screening tools in teenagers are the PHQ-2 for Adolescents7 and the primary care version of the Beck Depression Inventory.8

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Depression in older persons. Appropriate screening tools include:

  • PHQ-29
  • PHQ-910
  • Cornell Scale for Depression in Dementia (19-items)11
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Depression in older persons (cont.). Another appropriate screening tool for elderly patients is the Geriatric Depression Scale, which is 15 or 30 items for older adults without dementia.9

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Postpartum depression. The USPSTF,1 AAFP,2 AAP,12 and ACOG13 recommend screening all women for depression at least once during pregnancy as well as post-partum. The PHQ-2 and PHQ-9 are recommended screening tools.5

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Postpartum depression (cont.). The Edinburgh Postnatal Depression Scale is the most commonly used screening tool for postpartum depression and is available in 50 languages.14

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Additional screening tools during COVID-19: • Depression, Anxiety, and Stress Scale (DASS)
• Impact of Event Scale Revised (IES-R) • Maslach Burnout Inventory (MBI) • Hamilton Anxiety Scale (HAMA, 14 items)/Hamilton Depression Scale (HAMD, 21 items) • Single question screen for substance use disorders • Drug Abuse Screening Test (DAST-10) • COVID-19 Stress Scale (CSS) • Coronavirus Anxiety Scale

References:

1. US Preventive Services Task Force. Depression in adults: Screening. Published January 26, 2016. Accessed December 16, 2020. 2. American Academy of Family Physicians. Clinical preventive service recommendation: Depression. Accessed December 16, 2020. 3. Pfizer. Patient Health Questionnaire (PHQ) Screeners. Accessed December 16, 2020. 4. Maurer DM, Raymond TJ, Davis BN. Depression: Screening and diagnosis. Am Fam Physician. 2018;98:508-515. 5. Arroll B, Goodyear-Smith F, Crengle S, et al. Validation of PHQ-2 and PHQ-9 to screen for major depression in the primary care population. Ann Fam Med. 2010;8:348-353. 6. US Preventive Services Task Force. Final recommendation statement: Depression in children and adolescents: Screening. . Published February 8, 2016. Accessed December 16, 2020. 7. Richardson LP, Rockhill C, Russo JE, et al. Evaluation of the PHQ-2 as a brief screen for detecting major depression among adolescents. Pediatrics. 2010;125:e1097-e1103. 8. Winter LB, Steer RA, Jones-Hicks L, Beck AT. Screening for major depression disorders in adolescent medical outpatients with the Beck Depression Inventory for Primary Care. J Adolesc Health. 1999;24:389-394. 9. Tsoi KK, Chan JY, Hirai HW, Wong SY. Comparison of diagnostic performance of Two-Question Screen and 15 depression screening instruments for older adults: Systematic review and meta-analysis. Br J Psychiatry. 2017;210:255-260. 10. Phelan E, Williams B, Meeker K, et al. A study of the diagnostic accuracy of the PHQ-9 in primary care elderly. BMC Fam Pract. 2010;11:63. 11. Kørner A, Lauritzen L, Abelskov K, et al. The Geriatric Depression Scale and the Cornell Scale for Depression in Dementia: A validity study. Nord J Psychiatry. 2006;60:360-364. 12. Rafferty J, Mattson G, Earls MF, Yogman MW; Committee on Psychosocial Aspects of Child and Family Health. Incorporating recognition and management of perinatal depression into pediatric practice. Pediatrics. 2019;143:e20183260. 13. American College of Obstetricians and Gynecologists’ Committee on Obstetric Practice. The American College of Obstetricians and Gynecologists Committee opinion no. 630. Screening for perinatal depression. Obstet Gynecol. 2015;125:1268–1271. 14. Agency for Healthcare Research and Quality. Comparative Effectiveness Review no. 106: Efficacy and safety of screening for postpartum depression. https://effectivehealthcare.ahrq.gov/sites/default/files/pdf/depression-postpartum-screening_research.pdf. Published April 2013. Accessed December 17, 2020.

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