USPSTF Announces New Guidance for Depression, Anxiety Screenings

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The U.S. Preventive Services Task Force (USPSTF) has developed new guidelines calling for more primary care screenings for major depression disorder (MDD) and anxiety.

The new guidelines call for MDD screening for adults, including pregnant and postpartum individuals and those aged 65 years and older, which would have a moderate net benefit. However, there is insufficient evidence on the benefit and harms of screening for suicide risk in adults, including pregnant and postpartum individuals and older adults.

For the depression guidance, the investigators targeted asymptomatic adults aged 19 years and older, including pregnant and postpartum individuals.

For anxiety, there is moderate certainty that screening for anxiety disorders in adults, including pregnant and postpartum individuals, has a moderate net benefit, but there is insufficient evidence on screening for anxiety disorders for adults aged 65 years and older.

The recommendations are based on 14 primary studies involving 8819 patients and 10 existing systematic reviews involving approximately 75,000 individuals on the accuracy of screening tests for detecting depression. There were also 17 screening trials involving 18,437 patients directly addressing the benefits of screening for depression on health outcomes.

In an accompanying editorial, Gregory E. Simon, MD, MPH, Kaiser Permanente Washington Health Research Institute, Julie E. Richards, PhD, MPH, Department of Health Systems and Population Health, University of Washington School of Public Health, and Ursula Whiteside, PhD, NowMattersNow.org, explained their views on the new guidelines.

“The renewed recommendation for depression screening is expected and should prompt little controversy,” the authors wrote. “In contrast, the finding that evidence is insufficient to recommend for or against screening for suicide risk will likely meet objections.”

According to 2019 statistics, 7.8% (n = 19.4 million) of adults in the US experienced at least 1 major depressive episode, with 5.3% (n = 13.1 million) experienced a major depressive episode with severe impairment.

Depression is also very common in postpartum and pregnant individuals and can affect both the parent and the offspring and increases the risk of preterm birth and low birth weight or small-for-gestational age.

There are many tests currently available for depression screening that could be used in primary care, including the Patient Health Questionnaire (PHQ) in various forms in adults, the Center for Epidemiologic Studies Depression Scale (CES-D), the Geriatric Depression Scale (GDS) in older adults, and the Edinburgh Postnatal Depression Scale (EPDS) in postpartum and pregnant persons.

There are also several screening instruments available to evaluate suicide risk, including the Beck Hopelessness Scale, the SAD PERSONS Scale (Sex, Age, Depression, Previous attempt, Ethanol abuse, Rational thinking loss, Social supports lacking, Organized plan, Nospouse, Sickness), and the SAFE-T (Suicide Assessment Five-step Evaluation and Triage).

One of the reasons for the new guidelines is there is currently very little evidence on the optimal timing for depression screening, with more evidence needed in both perinatal and general adult populations.

“In the absence of evidence, a pragmatic approach might include screening adults who have not been screened previously and using clinical judgment while considering risk factors, comorbid conditions, and life events to determine if additional screening of patients at increased risk is warranted,” the authors wrote. “Ongoing assessment of risks that may develop during pregnancy and the postpartum period is also a reasonable approach.”

For anxiety, the prevalence for men was 26.4% and 40.4% for women between 2001-2002. In addition, generalized anxiety disorders had an estimated prevalence of 8.5-10.5% during pregnancy and 4.4-10.8% during the postpartum period.