Screened for depression

Should everyone be screened for depression?

Smoking, weight loss and anxiety are the most common problems seen by hypnotherapists. But many of the problems that clients seek help with are actually symptoms of depression. Depression is the leading cause of disability worldwide (WHO, 2017), If it is so common, should everyone be screened for depression?

Why not screen everyone?

On the face of it, this would seem like a very sensible option. At the very least we could screen pregnant women and teenagers. Early intervention would seem to be very desirable. And it has been proposed many times by many organisations. So why is it not being done?

The main reason is the fear that it would lead to overtreatment. This concern is so prevalent that medical associations in Canada and the UK have a policy of opposing routine mental health screening for everyone.

It is argued that routine screening has not proved to be effective. In fact, it can prove to be counter-productive. Someone going through a temporary session of "the blues" might acquire a lifelong label. They may actually get depressed through worry, and may spend time and money seeking treatment they don't actually need. Giving people SSRIs that they don't need opens up to unnecessary side-effects of the drug. Too many false positives might make the problem worse.

This is not to suggest that doctors should not screen patients they suspect have depression. However they should not routinely apply it to everyone who presents to them.

Publication bias

The research that has been done on the benefits of screening have not shown good results. Screening has proved effective at identifying problem cases, but the outcomes have been very modest. Medical associations worry that the results show "publication bias". This is the tendency to only report positive or significant research. Editors of medical journals prefer to fill their journals with reports of success. For every successful trial, there may be three or four unsuccessful trials. The trials where the results were just not very clear don't get published. So when looking through published results it appears that the situation is much better and much clearer than it actually is.

Another reason for not doing routine screening is that it would be captured by the pharmaceutical companies. They would see this as a bonanza for their products. In fact, at least one of the most used questionnaires for depression was developed with funding from a pharmaceutical company.

I am not a supporter of the conspiracy theories against "Big Pharma". Pharmaceutical companies produce wonderful products that keep the population healthy and well. They are entitled to make a profit and to market their products. However, routine screening of 100% of the population would lead to a blowout of virtually every health authority's budget.

Without a guarantee of a clear and measurable benefit it is just not worth it.

David Mason

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