Guidelines for preventive activities in general practice

Mental health and substance use

Depression

      1. Depression

Mental health and substance use | Depression

Case-finding age bar

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 70–74 75–79 ≥80
*from age 12 years
 

Major depressive disorder is a high-prevalence condition in Australia. It is estimated that 9% of men and 14% of women aged 16–85 years have experienced at least one depressive episode in their lives, with a 12-month prevalence of 4% and 6%, respectively.1 A depressive episode may occur in the absence of major depressive disorder (eg as a consequence of seasonal associated disorder).1 Given that GPs provide most of all mental health care, including depression care. in Australia, it is appropriate that they use screening and case finding according to population groups as outlined in the recommendations below. This is in light of mixed evidence for the effectiveness of universal screening for major depressive disorder, depending on the context of the patient population, and the level of system support available.

Screening

Recommendation Grade How often References
General population screening for depression is not recommended.
 
Generally not recommended N/A 2,3,4

Case finding

Recommendation Grade How often References
Be alert to signs of depression in adolescents aged 12-18 years with risk factors. See Box 1. Conditionally recommended At every encounter 5,6,7,8,9,10
Be alert for the various symptoms of depression (eg low mood, substance use, insomnia, anhedonia, suicidal thoughts, fatigue and persistent somatic complaints) in the adult population. If present, use one of the validated mental health assessment tools to undertake further assessment (see Further information). Conditionally recommended Opportunistically 3, 5,11,12,13
 

Although there is evidence that depression screening instruments have reasonable sensitivity and specificity, the evidence for improved health outcomes and the cost-effectiveness of screening for depression in primary care remain 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 (eg via practice nurses).14 There is insufficient evidence to recommend routine screening in adults or adolescents where case management and coordination are not available.2,3,14 There is insufficient evidence to recommend screening in children.5 Clinicians should maintain a high level of awareness for depressive symptoms in patients at high risk of depression and make appropriate clinical assessments wherever the risk is high.11

Consider the use of the HEADSSS assessment tool for the assessment of depression in adolescents aged 12–18 years.

Consider using Sphere-12, the K10 anxiety and depression test, the Depression Anxiety Stress Scales (DASS) or the Depression self-report questionnaire (DMI-10 and DMI-18) for the assessment of depression in adults.15

Box 1. Risk factors for depression in adolescents aged 12–18 years5–10

  • History of depression
  • Family history of depression
  • Other psychiatric disorders, including substance misuse
  • Chronic medical conditions
  • Unemployment
  • Low socioeconomic status
  • Older adults with significant life events (eg illness, cognitive decline, bereavement or institutional placement)
  • All family members who have experienced family violence
  • Lesbian, gay and bisexual peoples
  • Experience of child abuse
  • Deliberate self-harm
  • Comorbid mental health or chronic mental health conditions
  • Experience of a major negative life event (including being bullied)

Universal screening for depression is not recommended among Aboriginal and Torres Strait Islander peoples. Identify those people in whom the risk of depression is greater as part of annual health assessments. Consider using one of the ‘social and emotional wellbeing’ or mental health assessment tools to guide the conversation. Options include the Kessler Psychological Distress Scale (K-5), the Here and Now Aboriginal Assessment (HANAA) tool, the Patient Health Questionnaire (PHQ)-9, PHQ-9 adapted, PHQ-2 and link-me.16

Medications are not recommended for the primary prevention of depression.16

For specific recommendations and advice for Aboriginal and Torres Strait Islander people, please refer to the Prevention of depression section in the National guide to a preventive health assessment for Aboriginal and Torres Strait Islander people.

  1. Australian Institute of Health and Welfare. Mental health. Australian Government, 2024 [Accessed 6 March 2024].
  2. U.S. Preventive Services Task Force (USPSTF). Depression and suicide risk in children and adolescents: Screening. USPSTF, 2022 [Accessed 5 March 2024].
  3. U.S. Preventive Services Task Force (USPSTF). Depression and suicide risk in adults: Screening. USPSTF, 2023 [Accessed 5 March 2024].
  4. Canadian Task Force on Preventive Health Care. Depression in adults. Canadian Task Force on Preventive Health Care, 2013 [Accessed 5 March 2024].
  5. Siu AL; U.S. Preventive Services Task Force. Screening for depression in children and adolescents: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med 2016;164(5):360–66. doi: 10.7326/M15-2957.
  6. Joffres M, Jaramillo A, Dickinson J, et al. Recommendations on screening for depression in adults. CMAJ 2013;185(9):775–82. doi: 10.1503/cmaj.130403.
  7. Lereya ST, Copeland WE, Zammit S, Wolke D. Bully/victims: A longitudinal, population-based cohort study of their mental health. Eur Child Adolesc Psychiatry 2015;24(12):1461–71. doi: 10.1007/s00787-015-0705-5.
  8. Sanci L, Lewis D, Patton G. Detecting emotional disorder in young people in primary care. Curr Opin Psychiatry 2010;23(4):318–23. doi: 10.1097/YCO.0b013e32833aac38.
  9. Thapar A, Collishaw S, Pine DS, Thapar AK. Depression in adolescence. Lancet 2012;379(9820):1056–67. doi: 10.1016/S0140-6736(11)60871-4.
  10. 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. NSW Centre for the Advancement of Adolescent Health and Transcultural Mental Health Centre, 2008.
  11. National Institute for Health and Clinical Excellence (NICE). Depression in adults: Treatment and management. NICE guideline [NG222]. NICE, 2022 [Accessed 5 March 2024].
  12. Health Quality Ontario. Screening and management of depression for adults with chronic diseases: An evidence-based analysis. Ont Health Technol Assess Ser 2013;13(8):1–45.
  13. King M, Semlyen J, Tai SS, et al. A systematic review of mental disorder, suicide, and deliberate self harm in lesbian, gay and bisexual people. BMC Psychiatry 2008;8(1):70. doi: 10.1186/1471-244X-8-70.
  14. Siu AL, Bibbins-Domingo K, Grossman DC, et al. Screening for depression in adults: US Preventive Services Task Force recommendation statement. JAMA 2016;315(4):380–87. doi: 10.1001/jama.2015.18392.
  15. General Practice Mental Health Standards Collaboration (GPMHSC). Suicide prevention and first aid resource tool kit. GPMHSC, 2016 [Accessed 5 March 2024].
  16. The Royal Australian College of General Practitioners (RACGP); National Aboriginal Community Controlled Health Organisation (NACCHO). National guide to a preventive health assessment for Aboriginal and Torres Strait Islander people. RACGP and NACCHO, 2018 [Accessed 5 March 2024].
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