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When to Screen?
Patient presents with symptoms of depression (Canadian Task Force on Preventive Health Care, 2013):
- Low mood
- Insomnia
- Anhedonia
- Suicidal thoughts.
High risk symptom presentations (CANMAT Guidelines, 2016):
- Unexplained physical symptoms
- Chronic pain
- Fatigue
- Insomnia
- Anxiety
- Substance abuse
High risk groups (CANMAT Guidelines, 2023):
- Past history of depression
- Family history of depression
- Psychosocial adversity, both past and present
- Higher users of the medical system
- Chronic medical conditions (e.g. cardiovascular disease, diabetes, chronic pain, neurologic disorders)
- Other psychiatric conditions especially anxiety disorders
- Times of hormonal challenge (e.g. puberty, peripartum and perimenopause)
- Bereavement
- Gender dysphoria
- Sedentary lifestyle/screen time
- Insomnia, night shift work
Note that in contrast to CANMAT (2016), the Canadian Task Force on Preventive Health Care (2013) does NOT recommend routinely screening adults in primary care who 1) have no apparent symptoms of depression, 2) are at average risk of depression, or 3) even those who may be at increased risk.
How to Screen
There are many ways to screen:
1. Two question screen (MacMillan et al, 2005):
“Over the past 2 weeks, have you felt down, depressed, or hopeless?”
“Over the past 2 weeks, have you felt little interest or pleasure in doing things?”
A positive response to either question warrants further assessment. A negative response to BOTH questions suggests that depression is unlikely.
These two screening questions have been shown to have a sensitivity 97% and specificity 67% (Aroll, 2003).
2. Consider using the PHQ-4 questionnaire PHQ-4
A score of 3 or greater on items 1 and 2 considered positive screen for anxiety
A score of 3 or greater on items 3 and 4 is considered positive screen for depression
3. Consider using the PHQ-9 questionnaire PHQ-9 in other languages | PDF | Online on MDCalc | Scoring instructions
If you have a high suspicion of depression, consider simply using the PHQ-9, which will allow for screening as well as provide an assessment of severity.