Guidelines for preventive activities in general practice

The Red Book
10.1 Depression
☰ Table of contents

Age range chart

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 (eg via practice nurses; B).31 There is insufficient evidence to recommend routine screening in adults or adolescents where case management and coordination is not available (C).31 There is insufficient evidence to recommend screening in children.32 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.33

Table 10.1.1. Depression: Identifying risk

Who is at risk?

What should be done?

How often?

Average risk

Adult population aged ≥18 years, where no risk factors for depression are identified 31

Be alert to possible depression, but do not routinely screen unless staff-assisted depression care supports are in place (C)


Increased risk

  • Past history of depression31
  • Family history of depression 33
  • Other psychiatric disorders, including substance misuse 34
  • Chronic medical conditions
  • Unemployment 35
  • Low socioeconomic status (SES)
  • Older adults with significant life events (eg illness, cognitive decline, bereavement or institutional placement) 36
  • All family members who have experienced family violence
  • Lesbian, gay and bisexual peoples
  • Experience of child abuse

Recurrent screening may be more useful in people deemed to be at higher risk of depression (B); however, in the case of people with chronic diseases (eg diabetes, heart failure, coronary heart disease), a screen-and-treat strategy for depression has not been shown to improve chronic disease symptoms nor reduce health service use 

Maintain a high level of clinical awareness of those at high risk of depression and consider depression when a person presents with suggestive symptoms such as low mood, insomnia, anhedonia, suicidal thoughts


Pregnant and postpartum women 31 

Risk factors for depression during pregnancy and postpartum include poor self-esteem, child care stress, prenatal anxiety, life stress, decreased social support, single/unpartnered relationship status, history of depression, difficult infant temperament, previous postpartum depression, lower SES, and unintended pregnancy

Recurrent screening may be more useful in people deemed to be at higher risk of depression (B) 31


Adolescents aged 12–18 years, particularly with32, 37–39:

  • family history of depression
  • deliberate self-harm
  • comorbid mental health or chronic medical conditions
  • experience of a major negative life event (including being bullied)

The benefits of screening alone have not been established, but screening is recommended where access to effective treatment and follow up is available 

Be alert for signs of depression in this age group (B)40, 41 

Consider use of HE2ADS3 assessment tool (refer to Practice Point m in Table 3.2)

At every encounter

SES, socioeconomic status

Table 10.1.2. Test to detect depression



Question regarding mood and anhedonia

Asking two simple questions may be as effective as longer instruments42:

  • ‘Over the past two weeks, have you felt down, depressed or hopeless?’
  • ‘Over the past two 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) 33 

In adolescents, consider use of HE2ADS3 assessment tool (refer to Chapter 3. Preventive activities in children and young people) 43 

In women in the perinatal period, the Edinburgh Postnatal Depression Scale (EPDS) can be used to detect women requiring further assessment of possible major depression (B in the postnatal period) at Black Dog Institute or Beyond Blue 

Refer to Section 10.3. Identification of intimate partner violence, as depression is a common reason for presentation in those experiencing violence

EPDS, Edinburgh Postnatal Depression Scale


  1. Siu AL, US Preventive Services Task Force. Screening for depression in adults, US Preventive Services Task Force recommendation statement. JAMA 2016;315(4):380–87.
  2. Siu AL, US Preventive Services Task Force. Screening for depression in children and adolescents: US Preventive Services Task Force recommendation statement. Ann Int Med 2016;164(5):360–66.
  3. National Collaborating Centre for Mental Health. National Institute for Health and Clinical Excellence: Guidance. Depression: The treatment and management of depression in adults (updated edition). Leicester (UK): British Psychological Society and Royal College of Psychiatrists, 2010.
  4. 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.
  5. 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;8:70.
  6. Canadian Task Force on Preventive Health Care, Joffres M, Jaramillo A, et al. Recommendations on screening for depression in adults. CMAJ 2013 Jun 11;185(9):775–82.
  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.
  8. Sanci L, Lewis D, Patton G. Detecting emotional disorder in young people in primary care. Curr Opin Psychiatry 2010;23(4):318–23.
  9. Thapar A, Collishaw S, Pine DS, Thapar AK. Depression in adolescence. Lancet 2012;379(9820):1056–67.
  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. Sydney: NSW Centre for the Advancement of Adolescent Health and Transcultural Mental Health Centre, 2008.
  11. McDermott B, Baigent M, Chanen A, et al. Clinical practice guidelines: Depression in adolescents and young adults. Hawthorn, Vic: beyondblue, 2010.
  12. 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.
  13. Austin MP, Highet N, the 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. Hawthorn, Vic: beyondblue, 2011.