Screening for Depression in Clinical Practice: An Evidence-Based Guide Book

List of Contributors xi

Preface Wayne Katon xv

1 Is the Syndrome of Depression a Valid Concept? Alex J. Mitchell Mark Zimmerman 3

What is Meant by Depression? 3

Value and Validity of the Syndrome Concept 7

Diagnostic Checklists (including DSM and ICD) 10

Unstructured (Unassisted) Clinician Diagnosis 15

Structured and Semi-Structured Assisted Diagnostic Interviews 19

Conclusion 22

References 24

2 Overview of Depression Scales and Tools Alex J. Mitchell 29

Background 29

The Classic Severity Scales (1960-1980) 36

The New Severity Scales (1981-2008) 39

The Future of Screening Scales 44

References 51

3 Why Do Clinicians Have Difficulty Detecting Depression? Alex J. Mitchell 57

Introduction to the Problem of Over- and Under-Detection 57

Predictors of Detection 62

Patient and Clinician Influences on Detection 66

Illness-Related Influences on Detection 71

Conclusions 74

References 75

4 How Can Existing Mood Scales Be Improved? How to Test, Refine, and Improve Existing Scales Adam B. Smith 83

Introduction 83

The Rasch Model and Other Item Response Models 86

Conclusion 95

References 96

5 How Do We Know When a Screening Test is Clinically Useful? Alex J. Mitchell 99

How Do Clinicians Make a Diagnosis? 99

Scientific Aspects of Diagnostic Accuracy 103

Clinical Aspects of Diagnostic Accuracy 105

Testing Screening via Implementation Studies 109

Conclusions 111

References 111

6 Clinical Judgment and the Influence of Screening on Decision Making Howard N. Garb 113

Introduction 113

Research on Clinical Judgment 114

The Limits of Screening 119

References 120

7 Implementing Screening as Part of Enhanced Care: Screening Aloneis Not Enough Simon Gilbody Dan Beck 123

The Case for Screening 123

Screening and Enhanced Care for Depression 128

New and Additional Evidence Relating to Enhanced Care 128

Is Screening a Necessary Intervention to Improve the Quality and Outcome of Care? 129

To Screen or Not to Screen? 136

References 137

8 Technological Approaches to Screening and Case Finding for Depression William H. Rogers Debra Lerner David A. Adler 143

Technological Methods of Screening for Depression 144

Ten Issues When Developing Computerized Screening for Depression 147

Examples of Implementation of Computerized Screening for Depression 150

Discussion 153

Conclusion 154

References 154

9 Screening for Depression in Primary Care: Can It Become More Efficient? Kathryn M. Magruder Derik E. Yeager 161

Introduction 161

Epidemiology of Depression in Primary Care 162

Is Screening for Depression in Primary Care Worthwhile? 165

Which Screening Tool Should Be Used? 169

Implementing Screening in Primary Care 178

What Developments Are on the Horizon? 183

Conclusions 185

References 185

10 Screening for Depression in Medical Settings: Are Specific Scales Useful? Gordon Parker Matthew Hyett 191

An Introductory Logic 191

Depression in the Medically Ill 192

"False-Positive" Depression Reflecting Confounding by Physical Symptoms Associated with Medical Illness 193

Screening Measures Used to Assess Depression in the Medically Ill 194

Discussion 198

References 199

11 Screening for Depression in Medical Settings: The Case Against Specific Scales Fariba Babaei Alex J. Mitchell 203

Overview of Depression in Physical Disease 203

Defining Somatic Symptoms 205

Diagnostic Accuracy of Somatic Symptoms in Depression 209

Evidence For and Against Somatic Symptoms when Diagnosing Comorbid Depression 211

Implications for Screening 217

References 236

12 Screening for Depression in Neurologic Disorders Andres M. Kanner 241

Depression in Stroke 242

Depression in Multiple Sclerosis 246

Depression in Epilepsy 249

Depression in Parkinson's Disease 255

Conclusions 258

References 258

13 Screening for Depression in Cancer Care Linda E. Carlson Sheena K. Clifford Shannon L. Groff Olga Maciejewski Barry D. Bultz 265

Prevalence of Depression in Cancer Care 265

Screening Methods for Depression 266

Screening for Depression in Oncology 267

Implementing Screening Programs in Oncology Settings 276

Special Issues in Screening Cancer Patients 292

Summary, Integration, Future Directions 293

Acknowledgments 294

References 295

14 Screening for Depression in Perinatal Settings Jodi Barton Philip Boyce 299

Introduction: Perinatal Screening in Context 299

Why Screen, and What Are We Screening For? 301

Screening Practices in Perinatal Settings 303

Screening Guidelines and Recommendations 304

Evidence-Based Comparison of Screening Methods 305

Implementation in Practice: Does Screening Make any Real-World Difference? 310

Service Delivery and Treatment Implications 311

Summary and Key Recommendations 313

References 314

15 Screening in Cardiovascular Care Brett D. Thombs Roy C. Ziegelstein 317

Depression in Cardiovascular Disease 318

The Prevalence of Depression in Cardiovascular Disease 319

Screening Instruments for Depression in Cardiovascular Care 320

Recommendations for Evaluation and Treatment of Patients in Cardiovascular Care 326

Conclusions 328

References 329

16 Screening in Diabetes Care: Detecting and Managing Depression in Diabetes Norbert Hermanns Bernhard Kulzer 335

Depression in Diabetes is a Major Health Problem 337

Screening Tests 340

Treatment Options 343

Screening Program 344

Conclusions for Clinical Practice 345

References 346

17 Commentary and Integration: Is it Time to Routinely Screen for Depression in Clinical Practice? James C. Coyne 349

Integration: Deflating the Puffer Phenomenon and Making the Case Against Screening 364

References 366

Appendix 371

Index 385