In primary care settings, the recommended approach to identifying depression begins with two key screening questions: "During the last month, have you often been bothered by feeling down, depressed or hopeless?" and "During the last month, have you often been bothered by having little interest or pleasure in doing things?" These questions serve as initial case-finding tools to alert practitioners to possible depression NICE NG222,NICE CG91.
Following a positive response to either question, if the practitioner is competent to perform a mental health assessment, they should conduct a more detailed review of the person's mental state, including functional, interpersonal, and social difficulties NICE NG222. To enhance diagnostic accuracy, especially in patients with chronic physical health problems, three additional questions about feelings of worthlessness, poor concentration, and thoughts of death may be asked NICE CG91.
Validated symptom rating scales are recommended to support assessment and monitoring of depression severity and treatment response. The NICE guidelines specifically endorse the use of validated measures such as the Patient Health Questionnaire-9 (PHQ-9) and the Edinburgh Postnatal Depression Scale (EPDS) for perinatal women NICE NG222,NICE CKS,NICE CKS,NICE CKS. The PHQ-9 is widely used in primary care for adults, while the EPDS is tailored for antenatal and postnatal depression screening NICE CKS,NICE CKS.
For patients with communication difficulties, alternative approaches such as the Distress Thermometer or obtaining collateral information from family or carers are advised to identify possible depression NICE NG222,NICE CG91.
Recent literature supports the use of these brief screening questions and validated tools in primary care, highlighting their utility in improving detection rates of depression, although under-detection remains a challenge in some settings Fekadu et al. 2022. Additionally, while bipolar disorder screening tools exist, depression identification in primary care primarily relies on the two-question case-finding method and validated symptom scales Hoyle et al. 2015.
Key References
- NG222 - Depression in adults: treatment and management
- CG91 - Depression in adults with a chronic physical health problem: recognition and management
- CKS - Depression
- CKS - Depression - antenatal and postnatal
- CKS - Antenatal and postnatal depression
- CKS - Postnatal and antenatal depression
- (Hoyle et al., 2015): Available screening tools for adults suffering from bipolar affective disorder in primary care: An integrative literature review.
- (Olariu et al., 2015): DETECTION OF ANXIETY DISORDERS IN PRIMARY CARE: A META-ANALYSIS OF ASSISTED AND UNASSISTED DIAGNOSES.
- (Fekadu et al., 2022): Under detection of depression in primary care settings in low and middle-income countries: a systematic review and meta-analysis.