Should we screen for depression? Caveats and potential pitfalls

The availability of brief screening instruments encourages their routine us e in identifying individuals who are presumed to be at risk for clinical de pression. In primary medical care where this idea has been most tested, how ever, there is little evidence that screening by itself improves the outcom e of depression. Reasons why screening cannot serve as an efficient basis f or 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 und ertaken only when the resources are available for interpreting the signific ance of positive screen scores, appropriate and acceptable interventions ar e available, and potential negative effects of screening can be avoided. Un til these conditions can be met, alternatives to screening should be consid ered.