Can the introduction of screening provide protection against depression?

Use a screening for depression at the family doctor?

Depression is increasing worldwide. Since the better the mental illness can be treated the sooner it is diagnosed, early detection projects have been started in some countries. In this country, too, it is considered whether a screening at the doctor could be useful. Experts doubt the benefits.

More and more people are suffering from mental illness

According to a World Health Organization (WHO) report, the number of people with depression worldwide has increased significantly. In Germany and the EU too, more and more people are suffering from the mental illness. According to the Institute for Quality and Efficiency in Health Care (IQWiG), nearly twelve percent of all adults in Germany are diagnosed with depression during their lifetime. If the mental illness is detected early, it can usually be better treated. Therefore, there is the consideration of whether a medical screening for depression could be useful.

The search for depression by means of a medical screening would, according to experts, bring advantages and disadvantages. (Image: Africa Studio / fotolia.com)

Advantages or disadvantages of a screening

The Institute for Quality and Efficiency in Health Care (IQWiG) has examined whether it could have advantages or disadvantages for participants in a screening, for example, if family doctors regularly offer a test on the basis of a questionnaire that can give evidence of depression.

As the institute writes in a communication, one advantage could be that the diagnosis can be made early and therapy can be started.

The final report, which has now been published, confirms the preliminary results: benefits and losses are therefore still unclear.

This still lacks the scientific basis to introduce such a screening.

Better treatment options with early diagnosis

As the experts explain, (unipolar) depression is usually in episodes: there may be periods of little or no discomfort, followed by periods when symptoms, especially depression and listlessness, may recur or increase.

For example, one benefit of the screening could be that the disease can be detected earlier and then better treated.

For example, it would be possible to prevent those affected from permanently withdrawing from social life or becoming incapacitated for work.

If depression is not recognized in time and treated consistently, it can become chronic. The treatment is traditionally with medications (antidepressants) and psychotherapy.

On the other hand, the screening could cause damage if the test results in a so-called false-positive result, ie indicates depression, but the affected person is not even ill at all.

The finding could emotionally burden her unnecessarily. You may be suffering from the side effects of medications they do not need.

Only a few countries have introduced the screening

For the final report, the same studies were available to the scientists as for the preliminary report: From the total of seven prospective planned intervention studies no reliable statements could be derived.

Because either the results between participants and non-participants of the screening did not differ at all or the differences were too small to be medically relevant.

For the five studies from Japan, the results are hardly transferable to the German healthcare context anyway.

The fact that some committees and medical societies recommend a screening for depression in the USA does not see department head Stefan Sauerland as a contradiction:

"Hardly any Western countries are actively seeking screening for depression because of the lack of data," said the expert.

In addition, the recommendation in the US does not refer to the screening alone, but to an overall strategy that ensures that all persons with a "positive" test result can also receive appropriate medical care.

"Incidentally, there is also no evidence to the benefit and harm of currently heavily promoted screening apps," said Sauerland. (Ad)