Drawbacks and Misuse of Depression Screening

09 October 2020 / By Social Media

Depression is a common mental disorder that affects millions across the world. In India, according to the National Mental Health Survey 2015-16, one in 20 Indians suffer from depression (WHO). It is one of the leading causes of disease burden worldwide and ranked as the second leading cause of disability. It is also a contributor to the global burden of diseases.

Screening refers to a procedure or program that used to detect early signs of a disease in an individual or population (APA). Screening of depression can lead to early diagnosis of the disorder, which leads to early treatment. It involves routinely asking about symptoms of depression, even if the patients do not mention them. Depression is not only characterized by feelings of sadness, but also by a lack of interest in activities, decreased energy, insomnia, weight changes, feelings of loss and worthlessness, and hopelessness. The stigma associated with depression often prevents individuals from bringing up these symptoms with their therapists or doctors. However, screening opens this door and allows the patients to describe their emotions and feelings and alleviate their suffering. The Beck Depression Inventory is the most extensively used screening tool worldwide.

While screening appears to be a straightforward and beneficial process, it can lead to over-diagnosis and over-treatment of depression. Screening tests cannot judge clinical significance. They aren’t specific and often end up identifying a large number of people as depressed who really aren’t and who would generally benefit from natural resilience, family support, or brief counseling. Many patients identified by screening techniques have transient symptoms (possibly related to life events), not proper depressive disorders and thus do not require treatment (Luchins, 2010). Depression screening further increases the unnecessary prescription and overuse of antidepressants which created creates unnecessary costs for the patients and has potential side effects. It also poses the problem of stigma and mislabelling.

Although screening tools are helpful, they should not be a substitute for clinical judgment. The patient's history, family history, and the presence of comorbidities should be taken into consideration when diagnosing or evaluating depression. It is important to understand that screening instruments should be used only to enhance, not replace, the clinical interview.


REFERENCES

  1. O., Connor, E., Rossom, R. C., Henninger, M., Groom, H., Burda, B., Henderson, J., & Whitlock, E. P. (2019). Screening for depression in adults: an updated systematic evidence review for the US preventive services task force [internet]. Rockville: Agency for Healthcare
    Research and Quality (US); 2016. (Evidence Syntheses, No. 128.).
  2. Luchins, D. J. (2010). Depression screening as a quality indicator. Mental health in family medicine, 7(2), 107.
  3. McGill University. (2016, August 2). Depression screening tools not accurate for children and adolescents: Researchers advise against routine screening in this age group. ScienceDaily.
  4. Roseman, M., Kloda, L. A., Saadat, N., Riehm, K. E., Ickowicz, A., Baltzer, F., Thombs, B. D. (2016). Accuracy of depression screening tools to detect major depression in children and adolescents: a systematic review. The Canadian Journal of Psychiatry, 61(12), 746-757.
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