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Clinical guidelines

Guidelines for preventive activities in general practice 8th edition

10.1 Depression

Age 0-9 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-79 >80

While there is evidence that depression screening instruments have reasonable sensitivity and specificity, the evidence for improved health outcomes and cost-effectiveness of screening for depression in primary care remains unclear. There is evidence for routine screening for depression in the general adult population in the context of staff-assisted support to the GP in providing depression care, case management and coordination (e.g. via practice nurses) (B).585 There is insufficient evidence to recommend routine screening in adults or adolescents where this level of feedback and management is not available (C).585 There is insufficient evidence to recommend screening in children.586 Clinicians should maintain a high level of awareness for depressive symptoms in patients at high risk for depression.

Table 10.1.1 Depression: identifying risk
Who is at risk?What should be done?How often?
Average risk
  • Adult population aged 18 years and older
Be alert to possible depression, but do not routinely screen unless staff-assisted depression care supports are in place (C). Opportunistically585
Adolescents
  • Aged 12-18 years, particularly with:
    • parental depression
    • comorbid mental health or chronic medical conditions
    • experienced a major negative life event
The benefits of screening have not been established, particularly where access to effective treatment and follow-up is not available.586,588
Be alert for signs of depression in this age group (B).
Consider use of HEADSS assessment tool112,587 (see Section 3: Preventive activities in children and young people)
At every encounter
Increased risk
  • Family history of depression
  • Other psychiatric disorders, including substance misuse
  • Chronic medical conditions
  • Unemployment
  • Low SES
  • Older adults with significant life events
    (e.g. illness, cognitive decline, bereavement or institutional placement)
  • All family members who have experienced family violence
  • Experience of child abuse
Recurrent screening may be more useful in people deemed to be at higher risk of depression (B)

Maintain a high level of clinical awareness of those at high risk of depression.
Opportunistically585
Table 10.1.2 Test to detect depression
TestTechnique
Question regarding mood and anhedonia Asking two simple questions may be as effective as longer instruments:589
‘Over the past 2 weeks, have you felt down, depressed or hopeless?’590
and
‘Over the past 2 weeks, have you felt little interest or pleasure in doing things?’
Asking a patient if help is needed in addition to these two screening questions improves the specificity of a GP diagnosis of depression (IV)
In adolescents, consider use of HEADSS assessment tool (see Section 3: Preventive activities in children and young people).
In women in the perinatal period, the Edinburgh Postnatal Depression Scale (also known as the EPDS) can be used to detect women requiring further assessment of possible major depression (B in the postnatal period) at www.blackdoginstitute.org.au/ docs/Cliniciansdownloadable Edinburgh.pdf or www.beyondblue.org.au/ index.aspx?link_id=103.885591
See also Section 10.3: Identification of intimate partner violence, as depression is a common reason for presentation in those experiencing violence.112,587

References

  1. McDermott B, Baigent M, Chanen A, Fraser L, Graetz B, Hayman N, et al; beyondblue Expert Working Committee (2010) Clinical practice guidelines: Depression in adolescents and young adults. Melbourne: beyondblue: the national depression initiative
  2. US Preventive Services Task Force. Screening for depression in adults, topic page. Rockville, MD: USPSTF, 2009 [accessed 2012 June]. Available at www.uspreventiveservicestaskforce.org/ uspstf/uspsaddepr.htm
  3. US Preventive Services Task Force. Screening and treatment for major depressive disorder in children and adolescents: clinical summary. Rockville, MD: USPSTF, 2009 [accessed 2012 June]. Available at www.uspreventiveservicestaskforce.org/ uspstf09/depression/chdeprsum.htm
  4. Chown, P, Kang M, Sanci L, Newnham V, Bennett DL. Adolescent health: enhancing the skills of general practitioners in caring for young people from culturally diverse backgrounds, GP Resource Kit 2nd edn. Westmead: NSW Centre for the Advancement of Adolescent Health, 2008
  5. Sanci L, Lewis D, Patton G. Detecting emotional disorder in young people in primary care. Curr Opin Psychiatry 2010;23(4):318–23
  6. National Collaborating Centre for Mental Health. Depression: the treatment and management of depression in adults. NICE clinical guideline 90. London: NICE, 2009
  7. Arroll B, Goodyear-Smith F, Kerse N, Fishman T. Effect of the addition of a ‘help’ question to two screening questions on specificity for diagnosis of depression in general practice: diagnostic validity study. BMJ 2005;331(7521):884
  8. Austin M-P, Highet N, Guidelines Expert Advisory Committee. Clinical practice guidelines for depression and related disorders – anxiety, bipolar disorder and puerperal psychosis – in the perinatal period. A guideline for primary care health professionals. Melbourne: beyondblue, 2011
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