Experts Concerned That Depression Screening Will Lead to Overdiagnosis

Behind the U.S. task force recommendation to screen all children and adults for depression

Zenobia Morrill
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In a recently published special report, Associate Editor of The BMJ, Jeanne Lenzer, critically calls into question the research methodologies and data underlying the latest U.S. task force recommendation to routinely screen for depression in all children and adults, aged 12 years and older, including pregnant and postpartum women.

“Some task force recommendations rely on questionable research methodologies, including the use of ‘indirect’ evidence; failure to include unpublished data; failure to check reported outcomes versus pre-specified outcomes; and, in at least one case, to have promulgated broad screening recommendations in the absence of a single randomised controlled screening trial (RCT).”

This past year’s recommendation follows a series of similar screening recommendations put forth by the United States Preventive Services Task Force (USPSTF). Lenzer notes this recommendation comes just after Congress significantly cut funds toward the Agency for Healthcare Research and Quality (AHRQ), the task force’s main government agency, in December of 2015.

“It is unclear what effects these threats have had. But in the past few years, the task force has issued several recommendations that are far more liberal in promoting interventions, which some experts say will lead to overtesting and overtreatment.”

The recommendations regarding routine universal depression screenings have sparked significant controversy among specialists in the field (see MIA report) in the past 15 years. Many of these experts, including the academic psychiatrist, Allen Frances, and psychiatry professor, Brett Thombs, express concerns with the risks involved in overdiagnosis, overtreatment, and unnecessary medicalization, especially when considering the potential harm involved in pathologizing sadness in adolescence.

Both the UK National Institute for Health and Care Excellence and the Canadian task force have decided against the recommendation of routine depression screenings, noting that there is not enough existing evidence to justify the potential harm involved in its implementation.  Lenzer builds upon this, in this report, by highlighting the lack of evidence, and particularly the fact that there are currently no randomized control trial (RCT) studies to support the aim of this recommendation:

“Because there are no RCTs of depression screening versus no screening that show a health benefit, the task force relied on evidence from studies of the accuracy of screening tests and, separately, of depression treatment approaches.”

Lenzer also highlights the USPSTF’s reliance on published, industry-funded data, despite the U.S. Food and Drug Administration (FDA) guidelines to attend to unpublished data. Similarly, although evidence indicates outsourced researchers are free of financial interests, the evidence-based practice centers (EBCs) where the data are outsourced and conducted, are industry funded.

“Given the history of Congressional punishment of the AHRQ for publishing results believed to interfere with industry interests, conflicts at the institutional level—rather than individual researcher level—are of concern.”

Lenzer’s investigation of USPSTF raises important questions concerning the reliability of task force recommendations and the potential harm that may result from depression screenings. As Thombs describes, the evidence does not support benefits related to screenings of depression, yet there is evidence demonstrating the adverse outcomes linked to treatment through antidepressants, and the prevalence of over-diagnosis and over-treatment of depression in community and primary care settings in the U.S.

Heneghan, a co-author of the Cochrane review, provided The BMJ with this perspective:

“In the face of no evidence, or very low quality evidence, guideline writers should refrain from making recommendations. Indeed many guideline bodies would better serve clinical practice by making fewer recommendations: reflecting more of the uncertainty around treatment decisions. What we need are fewer recommendations and more high quality evidence to base decisions on. Currently we seem to be seeing the exact opposite.”

 

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Lenzer, J. (2017. Is the United States Preventive Services Task Force still a voice of caution? The BMJ. doi:10.1136/bmj.j743 (Abstract)

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Zenobia Morrill
MIA-UMB News Team: Zenobia Morrill is a graduate of the dual master’s counseling psychology program at Columbia University. As a doctoral student and researcher at the University of Massachusetts in Boston, she seeks to understand the context informing psychology research and the underlying social factors that influence individual psychology. She is currently involved in projects examining the impact of structural violence.

21 COMMENTS

  1. 1 in 5 with a diagnosis, 1 in 6 on psychiatric drugs. Perhaps they should be pointing out that what screening we’ve had has already led to over-diagnosis, and any more screening to come can only mean more over-diagnosis. Is there a saturation point? I don’t know. I imagine that some people still have to be around to run things. I only know you’ve now got this “peer support specialist” business to aid and abet in this diagnostic growth industry overall. Where money making is involved, it’s one complication after another it would seem.

  2. “Overdiagnosis” is kind of an oxymoron when it is impossible to actually determine who merits a diagnosis by any kind of objective criteria. There is no objective standard for diagnosis, therefore, no standard for “overdiagnosis,” which is a fundamental problem with the entire idea of diagnosing “mental illness” based on social constructs that have no valid, objective indicators of their presence or absence.

    — Steve

  3. ANY “diagnosis” is an over diagnosis.

    This is bone chilling and represents another immediate and urgent challenge to our imaginary movement. People have the right to refuse any such “screenings” and to not be given “stealth” screenings where you believe your doctor is just being pleasant when they ask you how you’ve been feeling lately.

    People need to be warned about the consequences of cooperating with such practices and to resist pressure by insurance companies, Medicare, etc. to cooperate. And we need to have some allied shrinks who can help us write a manual explaining what the “depression screening” is looking for, and what the “correct” and “incorrect” answers are so people can avoid being targeted.

    • I agree.

      How do we protect children in their schools. Many schools have school psychologists who go out screening students all the time. What happens to parents when they refuse to allow this to be done to their children? How do we prepare children from innocently falling into the trap of being screened?

      This is just an attempt to widen the nets more in order to catch more people.

      • Kids pose a major problem.

        As for adults, I have taken a number of “self-tests” online to supposedly screen you for depression. I know all the right things to say. I usually say 1 or 2 mildly depressed sounding things just so they won’t know I’m faking. Really not hard to fool ’em!

  4. HEALTH CARE FRAUD
    Whats the difference between White Collar Professional Mental Health Care Fraud and any other Health Care Fraud?

    BELOW:-

    https://www.google.co.uk/amp/www.bbc.co.uk/news/amp/39155543

    “….Cafe owner Lisa White, 56, from Broadstairs, claimed she needed an oxygen mask to breathe, and was paid more than £150,000 in benefits.

    However, investigators obtained undercover footage of her working in the cafe, and a video of her dancing.

    She admitted fraud and was jailed at Inner London Crown Court on Thursday….”

  5. So do more testing and find out that a lot of children, adolescents and adults are depressed, then what? Force them to see therapists and psychiatrists? How about create better communities with more opportunities for children and adolescents to play and be kids, how about better jobs and a better economy so parents do not have to worry about providing for their families, better workplace polices to allow for taking time off to care for aging parents, parenting education, and promoting nurturing environments for all.

    These screenings only cause extreme anxiety and “medical student syndrome”, where you become overly concerned about having illnesses. Let’s solve the underlying problems.

  6. I could have told you the results of this “study” without hearing the “results.” From what I read, others can, also. Screening for depression is a sham. Depression is really just the mind/body/soul in a corrective mode as “it” confronts life. It is has become such a tragedy that every breath you take becomes some awful illness needing drugs, treatment and such. There is psychological concept these modern day psychiatrists, psychologists, mental health/illness people like to hide under the rug. It is called “self fulfilling prophecy.” They do not want to have anything to with any psychology that shows how powerful the mind really is and can be without their toxic drugs and toxic therapy. They keep acting delusional; yet “self-help” books from all arenas of thought keep getting published, people are buying them; showing our less and less need for their idiotic control and push into the land of the zombies.

    • Ask Me! Ask Me! I will tell you exactly what to say so they will think you are depressed and then you get those little pills, and everyone is so happy; especially those people who prescribe those little pills. Honestly and tragically, most of those screenings are as they say easy to “psych” out and the screeners are so gullible. I really don’t like to divulge this; although I am a “fan” of the Enneagram and the MBTI and others (at least they don’t try to drug you) I can manipulate those answers to obtain any personality type I choose. However, as a deep-down ethical person of integrity, I really try to answer the questions to what I think, at the time, is may, most like me. Unfortunately, for me, I did “hooked” into the system and answered the questions in a way that I now realize helped them and hurt me. But, we have parted ways. I don’t mean to be religious; but, the only word I can think of is “ALLELUIA! ALLELUIA!”