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Depression: Screening and referral

Key points

  • Screen for depression in primary care settings only if supports are in place to ensure appropriate diagnosis, treatment and ongoing care.
  • People with a history of depression, significant physical illness or other mental health or addiction problems are a priority for depression screening.
  • Rule out other possible causes of symptoms, such as organic conditions and other mental health problems (these may also co-occur with depression).
  • Use the quick two-question screener when clients have significant risk factors.
  • The Patient Health Questionnaire can help with making a diagnosis, assessing severity and monitoring treatment response. The SIGECAPS mnemonic helps to assess symptoms.

Why screen? Prevalence

  • Major depression affects 11% of Canadians at some point in their lifetime and about 4% during any given year.
  • Estimates of lifetime prevalence across North America vary, but it is likely that 20% of North Americans will experience depression at some point in their lives.
  • Two to three times as many people have depressive symptoms but do not meet criteria for major depression.

Screening in primary care

  • Screening in primary care settings is recommended only if appropriate diagnosis, treatment and follow-up are available.
  • Screen people who have a history of depression, significant physical illness, especially if it causes disability, and other mental health problems such as dementia.

Screening protocols

Quick screen

A two-question screener for people who have risk factors for a major depressive episode. Ask:

  • "In the past month, have you lost interest or pleasure in things you usually like to do?"
  • "Have you felt sad, low, down, depressed or hopeless?"

If the person answers yes to at least one of these questions, follow up with a more detailed assessment.

Common risk factors for major depression include:

  • chronic insomnia or fatigue
  • unexplained somatic symptoms
  • chronic medical illness
  • recent cardiovascular event (e.g., myocardial infarction, stroke)
  • recent trauma (psychological or physical)
  • other psychiatric disorder
  • family history of mood disorder.

Diagnostic questionnaires

  • The Patient Health Questionnaire (PHQ-9) is a multipurpose instrument for screening, monitoring and measuring the severity of depression.

Download the PHQ-9.

  • SIGECAPS can be used as a checklist to assess symptoms of depression:

Sleep

Interest (reduced, with loss of pleasure)

Guilt (often unrealistic)

Energy (mental and physical fatigue)

Concentration (distractibility, memory disturbance)

Appetite (any change)

Psychomotor (slowing or increasing)

Suicide (thoughts, plans or behaviours)

Specialist referral

Refer the person to a specialist if:

  • the person has a co-occurring substance use problem, personality disorder and/or anxiety disorder
  • the person has severe symptoms (e.g., serious suicidality, psychosis,periods of mania)
  • you are unsure of the diagnosis
  • the person's response to standard treatment, such as cognitive-behavioural therapy or two or more medication trials, is poor.

Evidence summary

Canadian Task Force on Preventive Health Care. (2013). Recommendations on screening for depression in adults. Canadian Medical Association Journal, 185, 775–782.

Kennedy, S.H., Lam, R.W., Parikh, S.V., Patten, S.B. & Ravindran, A.V. (2009). Canadian Network for Mood and Anxiety Treatments (CANMAT) Clinical Guidelines for the Management of Major Depressive Disorder in AdultsJournal of Affective Disorders, 117(Suppl. 1). S44–53.

Lam, R.W. (2011). In D. Goldbloom & J. Davine (Eds.), Psychiatry in Primary Care: A Concise Canadian Pocket Guide (pp. 13–26). Toronto, ON: Centre for Addiction and Mental Health.

National Institute for Health and Care Excellence. (2009). Depression in Adults: The Treatment and Management of Depression in Adults (Clinical Guideline 90). London, UK: Author.


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