Guidelines in the US advocate for depression screening in adolescents in the hopes that mental health struggles can be identified early and that this will prevent them from becoming more problematic over time. But a new study found that there was no difference in outcome between those who were screened and those who were not.
They write, “The results of this study suggest that depression screening, as it is currently practiced in the US, may not deter avoidable health services use among adolescents.”
The research was led by Kira Riehm at Johns Hopkins University and published in the journal Preventive Medicine. (Full disclosure: I co-authored a paper on this subject with Riehm and other researchers in 2016).
Suppose screening was successful at connecting those who need it to treatment that improves depression. In that case, those who are screened should be less likely to need intensive care, such as ending up in the emergency department or hospitalized, and they should be less likely to attempt suicide.
However, Riehm and the other researchers found no difference between the group that was screened and the group that was not.
They write, “Being screened for depression was not consistently associated with emergency department use, inpatient hospitalizations, or medically-treated suicidal behaviors.”
The one exception was emergency department use specifically for mental health reasons—but screening appeared harmful, not helpful, for this outcome. Contrary to the expectation that screening would help improve depression (and thus prevent worse outcomes), the group who was screened for depression had a 16% higher risk of going to the emergency room because of their mental health.
The researchers suggest that one explanation for this finding is that screening has an iatrogenic effect, actually worsening mental health problems because it causes people to focus on them. They note that similar findings have been found in studies of pain screening, in which people who are screened report worsening pain afterward.
The study included 14,433 US adolescents who were screened for depression during a standard check-up. They were then followed for two years to assess emergency department use, hospitalizations, and suicide attempts.
For statistical comparison, each adolescent was matched with three others who had not been screened during their standard check-up. This matching process is designed to enable comparison between people who are similar in other ways; that helps to ensure that any effect is due to the screening rather than other factors.
“In conclusion,” the researchers write, “we found little evidence that being screened for depression during a well-visit influences the likelihood of subsequent ED use, inpatient hospitalizations, and medically-treated suicidal behaviors in a large, population-based sample of adolescents.”
Proponents of screening argue that it might help and that it’s unlikely to do harm. But other researchers have raised concerns that screening can lead to overdiagnosis and overtreatment, wasting healthcare resources, and potentially harming patients.
The UK and Canadian guidelines do not recommend screening for depression in primary care for adults or adolescents, since they could not find any evidence that screening benefitted patients. This is consistent with a 2008 Cochrane review, the 2016 study I co-authored, and several other studies with the same conclusion.
But the US guidelines do promote screening for depression (and anxiety, and other problems, including substance abuse and intimate partner violence) despite the lack of direct evidence that these are beneficial. This is mainly because the US guidelines focused on indirect evidence—studies that did not actually compare the outcomes of screening versus no screening—and concluded that screening could help, even though there was no direct evidence that it has benefits.
In April 2022, a draft report from the US Preventive Services Task Force admitted that screening children and adolescents specifically for suicide had no benefit. However, as evidenced in a STAT article about the report, many experts in the US continue to push for screening, primarily because they don’t know how else to help. The STAT article quotes Lisa Horowitz of the National Institute of Mental Health, who said, “In the meantime, what are you going to do with this mental health crisis? You cannot turn a blind eye.”
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Riehm, K. E., Brignone, E., Gallo, J. J., Stuart, E. A., & Mojtabai, R. (2022). Emergency health services use and medically-treated suicidal behaviors following depression screening among adolescents: A longitudinal cohort study. Preventive Medicine, 161, 107148. (Link)
This “screening” might have some value if it looked into subjects’ perceptual status as well as their moods, which could serve as a clue to appropriate medicating (having “depressed” patients suddenly going bananas is more of a sign of incompetent medicating than of “treatment resistance”).
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My suspicion is there’s a push for screening because providers and drug companies see it as a way to make money, not particularly because they want to help.
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I agree, the mainstream medical industry has found psychiatry’s and psychology’s scientific fraud based industries to be “too profitable” to not partake in, especially since the psychological and psychiatric industries are their systemic malpractice and child abuse covering up industries.
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Marie says, “…screening because providers and drug companies see it as a way to make money…”
This is exactly what’s going on. It’s all part of the drug companies’ marketing scheme; they write the tests and find the screenings to sell more psych drugs, and mainstream psychiatry happily plays along.
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We can’t ever have any kind of “mental health” screenings.
Joshua
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If your car won’t start, it doesn’t have bad starting health, it needs fuel. If people feel rotten, it’s not bad mental health, they lack essential human needs.
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Very well said!
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This is the first artcle that questions “screening” for depression or other mental illnesses. The subjectivity and bias of the questioner will automatically affect the results of those being screened. Additionally, the person being screened might not feel comfortable being honest. Please remember we are talking about “feelings.” For many, putting one’s feeling into words can be difficult, if not impossible. In adolescents, as in actually anyone being screened the desire to please the screener may far outweigh any worthwhile results. So, why do? Of course, money is the easiest answer. Additionally, the preoccupation of our culture and society with both numbers and their related quantifiable results. But, no matter what, from the beginning the bias of the the whole tool of screening invalidates it. But it sounds so good to those who only consider the statistics, the bottom line, and that etc. they’ll just keep doing, even if all it does is nothing. I wish this type of “behavior” was just confined to psychiatry. Dare I say, it is almost like both an obsession and a compulsion. It would be easier to stop, but it is really an epidemic of sorts in all types of institutions. Thank you.
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It is beyond silly to “screen” for something that you can’t objectively detect, and for which you have no effective “treatment” or intervention to offer. Such “screenings” are clearly an effort to increase their client base, and fit better into the rubric of marketing than they do of medicine. I recall a doctor once saying, “So I got a positive screen for depression. Now what am I supposed to do about it?”
Depression screenings are a scam and should be illegal.
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If you’re interested in screening, you might enjoy the actions of the Canadian Schizophrenia Foundation, an organization featuring patient participation and use of the Hoffer-Osmond Diagnostic Test (HOD) as a kind of psychiatric thermometer. They oversaw creating a pocket copy of same to use as a “psychiatric thermometer” to test yourself, so you could see how you’re doing, a psych version of your bathroom thermometer you could take with you on trips. Of course the CSF advocates for the orthomolecular nutritional treatment for disease, which will cerainly deny them credibility in the pharma-crossed USA.
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Steve says, “Depression screenings are a scam and should be illegal.”
The YouTube video “Psychiatry & Big Pharma Exposed – Dr. James Davies, PhD” shows just how much of a scam it all is, and leaves no doubt as to what’s really going on.
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So their final recommendation is, “We have to do something, so let’s do something stupid that makes things worse, because otherwise we’d be ‘turning a blind eye.'” How does that make sense?
I also noticed that the study doesn’t mention the very high possibility that screening led to SSRI “treatment,” which is associated with INCREASING suicide rates, especially in youth. This seems a likely explanation for at least some of the increase in ED visits.
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There is no such thing as Mental Illness, but we are classifying lots of stuff as Mental Illness.
Joshua
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Joshua, with all due respect, I have read many times your comments such as this one; “there being no such thing as mental illness.” There are many who post on this site who would agree with you and of course, there are those who post on this site who don’t. However, may question as I have read this repeatedly from you, what is your justification. If you were in a debate with someone who took the opposite position, what would you say that would solidify your position to help you win the debate. Thank you.
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The fallacy of ~Mental Illness~ is created by medicalizing people’s ordinary experience. It is used as a way to make people doubt their own experience. This Mental Illness fallacy is harmful to everyone touched by it.
Joshua
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I am sorry Joshua, with all due respect, you repeat the same thing over and over again. It is impossible to convince a doubting public without proof. It is impossible to make your case without proof. Yes, mental illness might be a fallacy, but is a fallacy of syntax; is it a fallacy of the mind; it is a fallacy a business. Yes, all could be truth but just stating it as a fallacy will get you nowhere. You say, “it is used as an excuse to make people doubt their own experience.” There might very well be truth in that, but you will need to prove it. You will need to study it; its pros and cons. Just stating it as a fallacy will hurt as many people as your claims that mental illness is a fallacy that has hurt people. I say all this as someone who has been hurt and who almost died because of the mental illness system (mostly the drugs, etc.) but, I know there are as many interpretations of almost anything that has to do with the brain and mind as there are people. Sadly, right now, I am NOT convinced and in fact, the statements that are continually made in your posts make me wonder if the reality of mental illness is more true than I previously thought even before I received my BA degree in psychology and then my experiences in the system. Thank you.
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The burden of proof is on those who want to say that their actually is such a thing as “Mental Illness”.
And know that you will be speaking to something which has already been addressed by Michel Foucault and R. D. Laing.
Do you think their is such a think as “Mental Illness”, and what do you think it is?
Joshua
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Breakfast News – Professor Joanna Moncrieff
https://youtu.be/2Ub7V0RcLew
A Decisive Blow to the Serotonin Hypothesis of Depression
The Empire is Falling
Evening Standard Newspaper 20 July 2022
Serotonin
University College London
https://youtu.be/MP1Y9f9JP1Q
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It was an unstable and unsound empire to begin with. Its disintegration should come as no surprise.
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Joshua, I would say that, perhaps, yes, in a perfect world the burden of proof would be on those who claim there is “mental illness.” But this is definitely not a perfect world, so if one wants to contend there is no “mental illness” they must be willing to back that statement up…. Thank you.
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The proper response to anyone saying that there is mental illness is always the middle finger. People have to learn to protect themselves, and each other.
R. D. Laing completed his psychiatry training and then was placed in charge of an asylum, the women’s section.
He treated them just by talking to them like he would anyone else, and by taking them all outside. He treated them with fresh air and sunlight.
Soon he felt that they were all well. Maybe not completely well, be well enough to go home.
But then within 6 months they were all back again.
So to Laing it seemed that this status of being ~mentally ill~ was being generated within The Family.
So he and Aaron Esterson set about to study this. The narratives, all true, and quite compelling.
https://www.amazon.com/Sanity-Madness-Family-Schizophrenics-Psychology/dp/0140134662
Free Online, but you have to register
https://www.perlego.com/book/1567537/sanity-madness-and-the-family-pdf
https://archive.org/details/sanitymadnessfam00lain
https://vdoc.pub/documents/sanity-madness-and-the-family-3v4j2jqmp2cg
You can get this on paper, but it looks like it can be downloaded or printed out for free ^.
Joshua
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Joshua, With all due respect, as long as you use the phrase, “gets the middle finger” then no matter how compelling your references are they fall on dead water. And people feel compelled or forced to believe something, which is what psychiatry does. Therefore the tragic irony in much of these post is that similar tactics are being used to obtain dissimilar results. However, the ends never ever justify the means. Thus, when attempting to dislodge any thing, idea, system, one must always consider how it is to be done. If one uses the same means, as many describe as psychiatric tactics, then, psychiatry, etc. no matter how bad or evil it might be always wins. With all due respect, in almost every post you make, psychiatry still wins. Thank you.
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Rebel, we have to stand up to, reject, and resist the mental health system at every level, do everything not expressly forbidden by law to oppose it and drive it into ground. Remember, we are protecting our health and well being. If pressed, there is nothing we cannot do to further that ends.
Joshua
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We should never expose ourselves to the mental health system, even to talk therapy.
Our thoughts are not subject to anyone else’s approval.
Joshua
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As a Primary Care Provider and Dad who lost his youngest son to suicide, I know the value of helping a person examine their life and feelings and make adjustments in relationships and circumstance. These are the “Determinants of Health (Quality of Life).” Folks, screening works, but only if we DO SOMETHING with the information! Screening for depression and then determining the person is not at risk for actively trying to kill themselves that night DOES NOTHING! You have to put an intervention in place and then stay with the person until their circumstance improves, or you’ve done nothing. The reason many of my former colleagues continue to believe screening, by itself, should be continued, is “cognitive dissonance.” We aren’t willing, able, to put resources behind practicing true Primary Care Prevention, but we will screen and then say “We are trying to help and doing something.” My son answered “Yes” to all the screening questions, was put on anti-depressant meds without proper close follow-up and caring, personal, intervention, and died ten days later. To say this means “screening doesn’t work” is simply not accurate. It means we do not listen to the person and appropriately respond to the data with meaningful short and long-term intervention. Period.
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I’d say screening works, in this case doing exactly what it was intended to do: create more customers for the psychiatric profession and the drug industry. The problem is the INTENTION of those doing the screening. If they actually wanted to help, the screening itself would look VERY different, and the range of responses would be much larger. So I agree with you, the screening itself is not the problem, it is the lack of intention of those providing “mental health treatment” to actually improve the situation that is at the core of the difficulties.
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