To screen for depression or not?
Screening may be appropriate to reconsider once we can ensure adequate response to any identified potential cases
Depression presents a significant public health challenge for both the community and the medical profession. In Australia, depression and anxiety affect a substantial proportion of the population (4.8% of men and 10% of women) and is responsible for 8% of the total loss in disability-adjusted life years.1 It is the top-ranking cause of non-fatal disease in the Australian community for women,2 and is also associated with an increased risk of ischaemic heart disease and suicide, both causes of early death.
Depressive disorders present diagnostic challenges, not least because in some cases depression is the first presentation of bipolar disorder. Further, treatment may be complicated and limited owing to the symptomatic heterogeneity of depression; complex comorbidities with anxiety, substance abuse, physical health problems or other factors; and the ongoing stigma that hinders many individuals from openly discussing their mood problems. As a result, rates of detection, diagnosis based on clinical presentation, and sufficient intervention remain inadequate. Indeed, a recent meta-analysis from the United Kingdom suggests that the diagnosis was only correct in 47% of cases presenting in primary care.3 This does not account…