Earlier this year, the US Preventative Services Task Force (USPSTF) came out with the controversial recommendation that all adolescent and adult patients undergo depression screening in primary care. A new study, published in the Canadian Journal of Psychiatry, calls this recommendation into question. Researchers led by Brett Thombs from McGill University reviewed the accuracy of the existing screening instruments used for the detection of depression in children and adolescents and found insufficient evidence for their use.
“The findings of the present review suggest important reasons why depression screening may be less effective than anticipated and could result in more harm than benefit,” the researchers write.
“If the evidence base for depression screening tools overestimates their accuracy, the use of these questionnaires in screening programs would likely lead to high false-positive rates, unnecessary labeling, overtreatment in some cases, and the consumption of scarce mental health resources that could otherwise be used to provide better care for children and adolescents with undertreated mental health problems.”
In 2016 the USPSTF reiterated its recommendation that adolescents should be regularly screened for depression during primary care visits. This recommendation was made despite the fact that no randomized clinical trials, the gold standard for “evidence-based” medicine, have been carried out to evaluate the effects of depression screening on children and young adults. While some trials have been carried out to test the effect of these screening procedures on adults, no well-conducted studies found this intervention to improve mental health outcomes. For these reasons, neither the UK or Canada have recommended regular depression screening.
Another controversy around regular depression screening centers around which questionnaires and tools should be used by physicians to accurately screen patients in their care. Previous trials and meta-analyses on the accuracy of the most common screening tools, the Patient Health Questionnaire for Adolescents (PHQ-A) and the Beck Depression Inventory–Primary Care version (BDIPC), may have inflated their effectiveness through their study designs. To test the accuracy of these instruments, the researchers conducted a systematic review of seventeen previous trials for depression screening tools in children and adolescents.
They found that the past studies “generally overestimate screening tool performance, sometimes substantially,” and that all of the studies they reviewed “failed to appropriately exclude children and adolescents already diagnosed or treated for depression… which can also lead to inflated estimates of screening tool accuracy.”
“There is increasing attention to the problem of overdiagnosis and overtreatment across areas of medicine,” the researchers conclude.
“In depression screening, overdiagnosis could result in the prescription of psychotropic medications to an increased number of children, who would be exposed to the adverse effects of these medications, even if they did not experience benefits from screening.”
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Roseman, M., Kloda, L.A., Saadat, N., Riehm, K.E., Ickowicz, A., Baltzer, F., Katz, L.Y., Patten, S.B., Rousseau, C. and 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, p.0706743716651833. (Research Gate)
In 2008, Anne Anderman and colleagues reviewed the respected criteria for screening written by Wilson and Younger.
Their final suggested update states: –
“The overall benefits of benefits of screening should out-way the harms”.
As the “Acceptable Treatment” is most likely to expose adolescents to the still poorly recognised,
extensive, potentially life threatening harms to self and/or others of SSRI’s with very limited if any benefits, these wise words of caution should be taken very seriously indeed.
Ref. Bull. World Health Organisation vol 86. n 4. Genebra April 2008.
Text corrected: –
“The overall benefits of screening should out-way harm”.
What the hell can they do with the depression screening?
1. Macro/Micro nutrient reports
2. Sleep reports
3. Pollution reports
4. General life coaches, along with reminders that its available to any student.
5. Heck, perhaps reduced price yoga/spa/massage relaxation stuff?
How will this not most likely just lead to more counterproductive pills? I was about to say that for adults with careers a therapist might be able to recommend a change in relationship or place of work/career, but that won’t work for children, and a financially successful one may try and convince their patient to see them forever, as some psycho-analysis “it takes 10 years to uncover your childhood, cha-ching”
Besides ensuring they get enough sleep, exercise, and other things, they can’t really do much that’s proven.
None of these screening programs are designed to help people. They are designed to label more people as ‘mentally ill’ so more people can be drugged to make even more profit for the pharmaceutical industry. That’s why, even though there is little evidence to support such screening programs, they are still pushed anyways. Because the psychopaths in power do not care about the people. They care about maintaining and expanding the status quo of power, profit, and control.
“… neither the UK or Canada have recommended regular depression screening,” why is the US encouraging drugging our children en mass?
“…the moral test of government is how that government treats those who are in the dawn of life, the children; those who are in the twilight of life, the elderly; those who are in the shadows of life; the sick, the needy and the handicapped. ”
~Last Speech of Hubert H. Humphrey
The wrong people have taken over the US government quite apparently.
Instead of supporting all this screening bologna, why don’t parents and teachers and coaches and other adults who deal with kids try LISTENING TO THEM?????? Why don’t parents and teachers actually talk with kids??? This is not rocket science you know. Parents are constantly running their kids to soccer practice, dance practice, this activity and that activity; but when do they ever stop and just sit down and talk with their kids? It doesn’t happen at the dinner table these days like it used to in the Beaver Cleaver days. Fewer and fewer teachers make themselves available to their students, especially in high school, just to listen to what their students want to share with them.
No, instead adults are all too quick to support these stupid screenings and the use of the so-called “antidepressants” which work absolutely no better than placebos. It would be better to give kids sugar pills than these devil’s tic tacs. Pills take less time and are less aggravating than actually dealing with kids.
This kind of stuff is destroying our society and our country and we just keep jumping over the cliff like all the other lemmings in front of us! When are adults going to stand up and say no in protection of their own kids?
Just as a little side note here. Do y9ou know, on average, how many adults a child has to tell that they’ve been sexually molested before an adult believes them and moves to do something about it? On the average it takes six to seven times that they child has to share this before someone does something about it. This is shameful. If adults paid more attention to what kids try to tell them we would have less reason to worry about the dreaded depression lurking among them!!!!
Most of the time kids just give up, believing that no one really cares about them. They quit talking and just give up, while the molester keeps having their way with them for years upon years. But we’d rather screen for depression and prescribe “antidepressants” than listen.
Hi Stephen,
Your excellent advice regarding listening to kids would also apply to adults being listened to instead of drugging them at every opportunity. You said:
“When are adults going to stand up and say no in protection of their own kids?”
Unfortunately, they usually feel the medical experts know best and wouldn’t be doing this screening if there wasn’t a good reason for it. Or is they question it, they get alot of pushback that is hard to resist.
Yes, you and I have talked before about how the medical field has gotten out of hand when it comes to the way doctors treat people these days. I too once had that unrealistic respect that so many people give to doctors. And then I trained in a university medical center where I had to work side by side with the older established doctors and the new “baby” doctors who were just starting out. Oh what an eye opener that year turned out to be. This was when I found out that doctors are just people like everyone else and some of them are not even particularly bright. Far too many of them were arrogant as could be while so many more of them felt that they were actually more important than all the other staff in the hospital. My unreal attitudes flew right out the window.
I’ve worked next to doctors for almost 26 years and I’ve run across some pretty good people with M.D. behind their names, but most of them needed to get a grip and take a long honest look at themselves in the mirror.
I respect the fact that many parents haven’t had the experiences I’ve had so they don’t realize that doctors aren’t the experts that they propose to be. I also know that many parents are threatened about losing their kids if they protest the drugging and labeling of the kids. I don’t know what to do in order to help parents find their own voices and authority and the courage to fight against the system that wants to drug their kids into oblivion. But we must start doing something soon or it will be too late. Generations of future adults have already been affected in ways that we can’t even begin to predict but I don’t think there will be lots of good outcomes. I don’t know what to do.