Screening and case finding instruments for depression

Background Screening or case finding instruments have been advocated as a simple, quick and inexpensive method to improve detection and management of depression in non‐specialist settings, such as primary care and the general hospital. However, screening/case finding is just one of a number of strategies that have been advocated to improve the quality of care for depression. The adoption of this seemingly simple and effective strategy should be underpinned by evidence of clinical and cost effectiveness. Objectives To determine the clinical and cost effectiveness of screening and case finding instruments in: (1) improving the recognition of depression; (2) improving the management of depression, and (3) improving the outcome of depression. Search methods The researchers undertook electronic searches of The Cochrane Library (Issue 4, 2004); The Cochrane Depression, Anxiety and Neurosis Group's Register [2004); EMBASE (1980‐2004); MEDLINE (1966‐2004); CINAHL (to 2004) and PsycLIT (1974‐2004). References of all identified studies were searched for further trials, and the researchers contacted authors of trials. Selection criteria Randomised controlled trials of the administration of case finding/screening instruments for depression and the feedback of the results of these instruments to clinicians, compared with no clinician feedback. Trials had to be conducted in non‐mental health settings, such as primary care or the general hospital. Studies that used screening strategies in addition to enhanced care, such as case management and structured follow up, were specifically excluded. Data collection and analysis Citations and, where possible, s were independently inspected by researchers, papers ordered, re‐inspected and quality assessed. Data were also independently extracted. Data relating to: (1) the recognition of depression; (2) the management of depression and (3) the outcome of depression over time were sought. For dichotomous data the Relative Risk (RR), 95% confidence interval (CI) were calculated on an intention‐to‐treat basis. For continuous data, weighted and standardised mean difference were calculated. A series of a priori sensitivity analyses relating to the method of administration of questionnaires and population under study were used to examine plausible causes of heterogeneity. Main results Twelve studies (including 5693 patients) met our inclusion criteria. Synthesis of these data gave the following results: (1) the recognition of depression