Screening for depression in high-risk groups: prospective cohort study in general practice

BACKGROUND: Currently only about half of the people who have major depressive disorder are detected during regular health care. Screening in high-risk groups might be a possible solution. AIMS: To evaluate the effectiveness of selective screening for major depressive disorder in three high-risk groups in primary care: people with mental health problems, people with unexplained somatic complaints and people who frequently attend their general practitioner. METHOD: Prospective cohort study among 2005 people in high-risk groups in three health centres in The Netherlands. RESULTS: Of the 2005 people identified, 1687 were invited for screening and of these 780 participated. Screening disclosed 71 people with major depressive disorder: 36 (50.7%) already received treatment, 14 (19.7%) refused treatment and 4 individuals did not show up for an appointment. As a final result of the screening, 17 individuals (1% of 1687) started treatment for major depressive disorder. CONCLUSIONS: Screening for depression in high-risk populations does not seem to be effective, mainly because of the low rates of treatment initiation, even if treatment is freely and easily accessible