Department of Psychiatry, McGill University, Montréal, Québec, Canada.
BMC Med. 2014 Jan 28;12:13. doi: 10.1186/1741-7015-12-13.
The United States Preventive Services Task Force (USPSTF) recommends screening adults for depression in primary care settings when staff-assisted depression management programs are available. This recommendation, however, is based on evidence from depression management programs conducted with patients already identified as depressed, even though screening is intended to identify depressed patients not already recognized or treated. The objective of this systematic review was to evaluate whether there is evidence from randomized controlled trials (RCTs) that depression screening benefits patients in primary care, using an explicit definition of screening.
We re-evaluated RCTs included in the 2009 USPSTF evidence review on depression screening, including only trials that compared depression outcomes between screened and non-screened patients and met the following three criteria: determined patient eligibility and randomized prior to screening; excluded patients already diagnosed with a recent episode of depression or already being treated for depression; and provided the same level of depression treatment services to patients identified as depressed in the screening and non-screening trial arms. We also reviewed studies included in a recent Cochrane systematic review, but not the USPSTF review; conducted a focused search to update the USPSTF review; and reviewed trial registries.
Of the nine RCTs included in the USPSTF review, four fulfilled none of three criteria for a test of depression screening, four fulfilled one of three criteria, and one fulfilled two of three criteria. There were two additional RCTs included only in the Cochrane review, and each fulfilled one of three criteria. No eligible RCTs were found via the updated review.
The USPSTF recommendation to screen adults for depression in primary care settings when staff-assisted depression management programs are available is not supported by evidence from any RCTs that are directly relevant to the recommendation. The USPSTF should re-evaluate this recommendation. Please see related article: http://www.biomedcentral.com/1741-7015/12/14 REGISTRATION: PROSPERO (#CRD42013004276).
美国预防服务工作组（USPSTF）建议在初级保健环境中为工作人员辅助的抑郁症管理计划提供时，对成年人进行抑郁症筛查。然而，这一建议是基于已经确定为抑郁症的患者进行的抑郁症管理计划的证据，尽管筛查旨在识别尚未被识别或治疗的抑郁症患者。本系统评价的目的是评估是否有随机对照试验（RCT）的证据表明，在初级保健中，使用明确的筛查定义，对患者进行抑郁症筛查是否有益。
我们重新评估了 2009 年 USPSTF 抑郁筛查证据审查中纳入的 RCT，仅纳入了那些比较筛查患者和非筛查患者之间抑郁结果的试验，并且符合以下三个标准：确定患者的资格并在筛查前随机分组；排除已经诊断出最近发作的抑郁症或已经接受抑郁症治疗的患者；为筛查和非筛查试验臂中确定为抑郁症的患者提供相同水平的抑郁治疗服务。我们还审查了最近 Cochrane 系统评价中纳入的研究，但未包括 USPSTF 审查；进行了重点搜索以更新 USPSTF 审查；并审查了试验登记处。
USPSTF 审查中纳入的九项 RCT 中，四项均不符合三项抑郁症筛查试验标准中的任何一项，四项符合三项标准中的一项，一项符合三项标准中的两项。在 Cochrane 审查中还纳入了另外两项 RCT，每一项都符合三项标准中的一项。通过更新的审查没有发现符合条件的 RCT。
USPSTF 建议在工作人员辅助的抑郁症管理计划可用时，在初级保健环境中对成年人进行抑郁症筛查的建议，没有任何直接相关建议的 RCT 证据支持。USPSTF 应重新评估这一建议。请参阅相关文章：http://www.biomedcentral.com/1741-7015/12/14 注册：PROSPERO（#CRD42013004276）。
