Should we screen for depression? Caveats and potential pitfalls

The availability of brief screening instruments encourages their routine use in identifying individuals who are presumed to be at risk for clinical depression. In primary medical care where this idea has been most tested, however, there is little evidence that screening by itself improves the outcome of depression. Reasons why screening cannot serve as an efficient basis for the prevention of depression are reviewed. Moreover, a positive score on a screening instrument does not indicate a clear need for intervention or the form that any intervention should take. Routine screening should be undertaken only when the resources are available for interpreting the significance of positive screen scores, appropriate and acceptable interventions are available, and potential negative effects of screening can be avoided. Until these conditions can be met, alternatives to screening should be considered.