Depression screening in adolescents and adults

What it is

Depression screening puts a short set of questions to people who have not raised mood as a problem. In adolescents and adults it is opportunistic screening, done with a screening questionnaire such as the PHQ-9. The U.S. Preventive Services Task Force recommends screening for major depressive disorder in adolescents 12 to 18 years of age, and it recommends that screening be put in place only alongside systems that ensure adequate diagnosis, effective treatment, and appropriate follow-up. This carries a B recommendation.

Causes and risk

Age sets the limit of the recommendation. For children 11 years of age and younger the evidence is insufficient to assess the balance of benefits and harms from screening, so the recommendation does not reach below adolescence. Pregnancy and the weeks after birth carry a rule of their own: all women should be screened for depression during pregnancy and the postpartum period.

Adjustment disorders are a further route into low mood. Their overall prognosis is favorable and most symptoms diminish over time without treatment, especially once the stressor is removed, yet some patients, and adolescents in particular, may keep a chronic course with a risk of secondary depression, anxiety and psychoactive substance abuse. Where a stressor is in the picture the differential diagnoses run: 1) adjustment disorder with depressed mood; 2) adjustment disorder with anxiety; 3) adjustment disorder with mixed anxiety and depression; 4) major depressive disorder. The clinical hint that decides between them is that when a patient meets the diagnostic criteria for major depressive disorder in response to a stressor, the diagnosis should be major depressive disorder and not adjustment disorder.