June 2024
Routine screening for depression in primary care: a randomised trial

Screening plus explicit feedback to patients and clinicians did not appear to improve outcomes.

The US Preventive Services Task Force recommends screening for depression in adults (NEJM JW Gen Med Aug 1 2023 and JAMA 2023; 329: 2163-2170), but evidence for improved outcomes is mixed. In this multisite study from Germany, 8000 adults were screened for depression with the Patient Health Questionnaire-9 (PHQ-9) in the waiting area prior to their primary care office visits. The 1030 patients who screened positive for at least moderate depression (score 10 or higher on the 27-point PHQ-9) were randomised to one of three groups: (1) no specific feedback to either patient or physician, unless the screen indicated suicidal ideation; (2) immediate written feedback only to the patient regarding the positive result, just before seeing the physician; or (3) immediate written feedback to both patient and physician about the positive result.

At six months, mean PHQ-9 scores had improved by several points in all three groups, with no significant differences among groups. Patients in the dual-feedback group were more likely to have discussed depression with their physicians, but actual treatment received was not different among groups; about 20% in each group were offered medication, and about 20% had seen a mental health specialist. Most other secondary outcomes were not meaningfully different across groups.

Comment: In this randomised trial, screening followed by explicit feedback to clinicians and patients had no substantial effect on depressive symptoms at six months. A benefit from screening rests on the assumption that patients with positive screens will receive effective treatment. But this assumption is highly dependent on primary care providers’ skills and time constraints and by access to specialised mental healthcare. For primary care clinicians whose practices routinely screen with PHQ or other instruments, this study illustrates the continuing challenges of making such screening a worthwhile exercise.

Peter Roy-Byrne, MD, Professor, Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle; USA.

Löwe B, et al. Clinical effectiveness of patient-targeted feedback following depression screening in general practice (GET.FEEDBACK.GP): an investigator-initiated, prospective, multicentre, three-arm, observer-blinded, randomised controlled trial in Germany. Lancet Psychiatry 2024; 11: 262-273.

This summary is taken from the following Journal Watch titles: General Medicine, Ambulatory Medicine, Psychiatry.

Lancet Psychiatry