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Level II – Depression Screening

Level II Services: Preventive services for which clinicians and care systems should assess the need. These services should be recommended to each patient as they have value, but less than those in Level I.

The USPSTF recommendations are fully endorsed by the ICSI Preventive Services work group.
Grade of Recommendation and Level of Certainty as Evaluated by USPSTF
  1. “Screening adults for depression when staff-assisted depression care supports are in place to assure accurate diagnosis, effective treatment, and follow-up.”
  2. “Against routinely screening adults for depression when staff-assisted depression care supports are not in place. There may be considerations that support screening for depression in an individual patient.”
(USPSTF Last Revised 2009 – Update in Progress)
Grade of Recommendation:
  1. B
  2. C

Level of Certainty:

  1. Moderate
  2. Moderate
“Benefits:
The USPSTF found good evidence that treating depressed adults and older adults identified through screening in primary care settings with antidepressants, psychotherapy or both decreases clinical morbidity.
The USPSTF found good evidence that programs combining depression screening and feedback with staff-assisted depression care supports improve clinical outcomes in adults and older adults.
The USPSTF found fair evidence that screening and feedback alone without staff-assisted care supports do not improve clinical outcomes in adults and older adults.
Harms:
The USPSTF found no evidence of harms of screening for depression in adults or older adults.
The USPSTF found at least fair-quality evidence that second-generation antidepressants (mostly selective serotonin reuptake inhibitors [SSRIs]) increase suicidal behaviors in adults ages 18 to 29 years, especially those with major depressive disorder (MDD) and those who receive paroxetine. The USPSTF found at least fair-quality evidence that SSRI use is associated with an increased risk for upper gastrointestinal (UGI) bleeding in adults older than age 70 years, with risk increasing with age.
Benefits-Harms Assessment:
The USPSTF concludes that for adults who receive care in clinical practices that have staff-assisted depression care supports in place, there is at least moderate certainty that the net benefit of screening for depression is at least moderate.
The USPSTF concludes that for adults who receive care in clinical practices without staff-assisted depression care supports in place, there is at least moderate certainty that the net benefit of screening adults for depression is small.”
Relevant Resources:
http://www.uspreventiveservicestaskforce.org/uspstf09/adultdepression/addeprrs.htm
ICSI Supplemental Information:
For additional resources refer to the ICSI Adult Depression in Primary Care document.