New guidelines recommend against routine screening for depression in Canada

TORONTO — At the doctor’s office, is it important to have your mental health assessed?

If Canadian adults aren’t showing any symptoms of depression, doctors shouldn’t conduct routine screening of mental health, updated national guidelines suggest.

The recommendation marks a change in approach from 2005 guidelines, which call for screening adults so long as clinics and hospitals have the systems to manage treatment.

The Canadian Task Force on Preventive Health Care’s latest update was published Monday in the Canadian Medical Associated Journal.

To make its recommendation, the panel scoured studies that compared people screened versus those who weren’t.

Their review didn’t lead to high quality evidence in favour of screening, according to Dr. Michel Joffres, chair of the task force’s depression guidelines working group.

Joffres is also a health sciences professor at Simon Fraser University in B.C.

“We have no evidence that detecting cases through screening makes a difference in important health outcomes,” Joffres told Global News.

“We are also concerned about false positive diagnoses with subsequent unnecessary treatment.”

The task force is an independent body made of fourteen doctors, but the working group behind the recommendations isn’t expert in the area of depression to avoid bias.

Even Canadians with an “increased risk” of depression — the illness is in family history, traumatic experiences as a child, substance abuse, for example — don’t need routine screening.

The changes come at a pivotal time – mental illness has been in the spotlight in Canada, especially among adults and in the workforce.

Recent polls suggest that one in five Canadian employees suffer from depression, with another 16 per cent conceding they’ve already experienced the condition before.

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Screening could be a matter of two to 30 questions — it’s not a diagnosis, but it could lead to a mental health review.

Instead of screening, Joffres said doctors should be alert to the symptoms of depression while checking on their patients, the task force said.

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“Physicians may notice clues or changes in the patient as soon as they walk through the door, mainly if they know these patients very well,” Joffres said.

Insomnia, bad mood, suicidal thoughts are just some of the signs, Joffres told Global News. Body language, fatigue, difficulty focusing, are other patterns doctors pay attention to.

Right now, there is no universal way for primary care doctors to look for depression in patients, said Dr. Keith Dobson, a clinical psychology expert at the University of Calgary. He conducts research and treats patients.

“There is a burden associated with the screening of any disorder because it takes time and energy and you run the risk of false positives,” Dobson said.

“This is one of the dilemmas we have in the mental health field. We don’t have physical tests for disorders.”

Instead, some doctors rely on the Patient Health Questionnare – or the PHQ-9 – which looks for nine possible symptoms of depression.

The worry in routine screening is over-diagnosing depression and providing patients with medications they may not need.

“Prescription rates are way out of line, they’re too high. It suggests that physicians are fairly quickly reaching for the prescription pad and over-identifying (depression), so not routinely screening may be helpful in not over-recognizing these cases,” he said.

The shift in screening aligns with recommendations in the United Kingdom. There, they call for a targeted approach, focusing on people with a history of depression.

Meanwhile, in the United States, its counterpart task force still recommends universal screening and follow up treatment.

carmen.chai@globalnews.ca

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