How Screening For and Treating Depression Makes a Difference

Most screening tests are fairly straightforward… frequently they are as basic as an x-ray or a lab test. This is not the case for depression, however.. With depression, the majority of symptoms are very subjective and personal for each individual. This means it is a little more complicated to screen for, but doesn’t mean that it’s not incredibly important.

In the United States, depression affects approximately 8% of individuals 12 years of age and older.¹ There are around 16 million adults who had at least one major depressive episode per year.² Worldwide, depression is the leading cause of disability.³

Common symptoms of depression are:⁴

• a lack of interest in doing things that would normally cause enjoyment

• depressed mood

• problems sleeping

• feelings of guilt

• worthlessness, or hopelessness 

• decreased energy levels 

• trouble concentrating 

• changes in appetite or eating habits

• a “slowing” of your motions

• suicidality

Depression symptoms tend to be displayed differently between women and men. Women with depression are more likely to report physical complaints such as muscle pain, headaches, and gastrointestinal issues. Women are also more likely to display emotional disturbance such as crying more easily.⁵ Men suffering from depression are more likely to be aggressive, and engage in substance abuse, risk-taking, and bursts of anger.⁶

Depression can essentially snatch somebody's life away. It is an incredibly terrible thing to suffer through, both for the individual with depression and their friends and family. It really can intensely impact those closest to the person suffering from depression. It is also the most common condition associated with suicide.⁷

People are at higher risk of depression if they have a history of anxiety, substance abuse, low self-esteem, recent or past traumas, divorce, death of a loved one (such as a spouse or parent), chronic medical problems, or poor social support systems. Females are at higher risk of depression than males.^8-10

Studies have shown that programs that combine screening for depression with having support systems and the ability to treat in place leads to improvement. These findings were indicated either by reducing symptoms or achieving full remission. This has proven effective in adults, adolescents between the age of 12 and 18, and pregnant and postpartum women. So screening not only helps with identification of people who have depression, but by using counseling (usually cognitive behavioral therapy), medications, or both therapies combined, people get better.¹¹

The tools that are used to screen for depression are questionnaires, where the person being screened is asked about specific symptoms. The questionnaires are basically a checklist, asking if the individual has had symptoms, and if so, how severe and frequent they have been. The PHQ (Patient Health Questionnaire) surveys are used most often. There’s a two-question version called the PHQ-2, and a longer nine-question version called the PHQ-9. The PHQ-2 only asks about the two most common features of depression, which are depressed mood and loss of interest or pleasure in doing things. The PHQ-9 goes more in-depth in asking about symptoms of depression. There are a couple of other commonly-used screening questionnaires, including the Edinburgh Postnatal Depression Scale which is more specific to postpartum depression, and the geriatric depression scale, which is more specific to the depression symptoms that older patients experience. All of the screening tools appear to be fairly similar in their effectiveness.¹²

Certainly the most important aspect of this screening recommendation is the second part, which emphasizes that this endeavor is only effective if there are adequate systems in place to deliver appropriate treatment. Depression treatment requires coordination, and very frequently uses more than one modality in its approach. That means that it doesn’t do any good to just have everyone over the age of 12 fill out a questionnaire every now and then. First of all, we really aren’t very good at prioritizing this in the clinic setting as of yet. A survey showed that only 5% of those who should have been screening actually were. More importantly, just screening doesn’t get to the root of the problem. It’s much more important that people understand how to recognize the symptoms of depression, whether it be their own symptoms, or those of someone they care about. 

Often, those who suffer from depression are resistant to ask for help, and there’s a number of reasons for this. People can feel embarrassed or ashamed, and can be concerned about the social stigma of dealing with a mental illness. Another problem that arises is that those with depression can lose their motivation for essentially everything, including taking the initiative to get the help that they need. So it’s important to look out for others, because people like this who have challenges with asking for help may need you to advocate for them. 

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