Doubt over depression questionnaire value

Good rapport with patients and strong consultation skill best for detecting depression.

The use of screening questionnaires for the detection of depression is making little improvement on traditional case finding, UK research suggests.

Depression affects 5-10 per cent of the population but it is estimated that about half of these cases are missed in primary care.

To help increase detection rates, NICE recommended the use of a two-item screening questionnaire as part of its guidance on depression.

Currently, GPs are awarded eight quality framework points for screening for depression in patients with diabetes and CHD using the two-item questionnaire.

But research suggests that using screening questionnaires does not significantly increase the number of cases of depression detected.

For the study, the researchers conducted a meta-analysis of 16 randomised controlled trials involving 5,996 patients that compared the use of depression screening tools with traditional case finding. Twelve of the studies were conducted in primary care.

Overall, the use of screening questionnaires increased the number of cases of depression that were detected by 3 per cent.

There was no significant effect of screening on the prescription of antidepressants and no impact on depression outcomes.

The researchers, led by Dr Simon Gilbody from the department of health sciences at the University of York, concluded that the use of screening questionnaires had no impact on the overall recognition rates of depression or on management of depression.

Dr Ian Walton, a GPSI in psychiatry in Sandwell, West Midlands, said: 'The questionnaire brings up very few surprises. The best method for spotting depression is to create a good rapport with the patient and use of good communication skills.'

CMAJ 2008; 178:997-1003

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