{"id":63983,"date":"2016-03-12T00:18:35","date_gmt":"2016-03-12T05:18:35","guid":{"rendered":"http:\/\/1boringoldman.com\/?p=63983"},"modified":"2016-03-13T16:03:25","modified_gmt":"2016-03-13T20:03:25","slug":"smoke-screens-2","status":"publish","type":"post","link":"https:\/\/1boringoldman.com\/index.php\/2016\/03\/12\/smoke-screens-2\/","title":{"rendered":"smoke screens…"},"content":{"rendered":"
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Editorial<\/font><\/strong><\/em><\/div>\n
US Preventive Services Task Force Recommendation Statement on Screening for Depression in Adults Not Good Enough<\/a><\/div>\n
by Charles F. Reynolds III, MD and Ellen Frank, PhD<\/div>\n
JAMA Psychiatry<\/font><\/strong>. 2016 73[3]:189-190.<\/div>\n

The US Preventive Services Task Force [USPSTF] has recommended screening for depression in the general adult population, including pregnant and postpartum women, with the use of brief, self-report instruments like the Patient Health Questionnaire 9 that typically take less than 5 minutes to complete. It further underscores the need for screening to be linked with adequate systems in place to ensure accurate diagnosis, effective treatment, and appropriate follow-up. The recommendation is silent, however, with respect to the ideal screening interval and the settings with highest potential yield. These are major shortcomings in our opinion.<\/p>\n

In our view, this recommendation, while more limited in scope than is warranted by the available data, is nonetheless of first-rank importance, given the immense public health burden of depression across the life cycle and its downstream sequelae. The latter include recurrence of major depressive episodes and chronic illness course, emergence of treatment resistance, poor adherence to treatment for coexisting medical disorders, amplification of disability and of family caregiver burden, and increased risk for dementia, suicide, and early mortality from co-occurring medical disorders.<\/p>\n

A central feature of the USPSTF recommendation, which we endorse whole-heartedly, is the need to integrate behavioral health services and primary care medicine. Most patients with major depression receive treatment in the general medical, not specialty mental health, sector. This state of affairs reflects patient preferences, issues of stigma that pose a barrier to help seeking [especially among racial and ethnic minorities], lack of an adequate mental health workforce, difficulties navigating the mental health care “system” and accessing expertise, and financial barriers to receiving mental health services…<\/p>\n

Our view is that the risk architecture inherent in major depression should inform recommendations for screening intervals, especially in patients who have experienced episodes of major depression. In our opinion, annual screening for depression and its recurrence would be medically appropriate, given the liability of patients with previous episodes for recurrence and chronicity. There is now a strong evidence base for the efficacy of maintenance pharmacotherapy and psychotherapy to reduce the risks for recurrence and chronicity…<\/p>\n

Another strong rationale for shorter screening intervals, on the order of 6 to 12 months, is the high prevalence of subsyndromal depression in primary care patients, especially in persons living with psychosocial and medical risk factors. Such patients can benefit from what has been termed by the Institute of Medicine indicated<\/em> prevention of depression (and other associated common mental disorders) in order to prevent transitions to episodes of frank clinical (major) depression or to prevent chronicity of subthreshold symptoms and their disabling effects…<\/div>\n<\/blockquote>\n
Since 2011, I’ve been following Statistician Robert Gibbons<\/font> after discovering that he was on the war-path to reverse the Black box warning on antidepressants [see tortured numbers…<\/a> and ]. But then, a couple of years later, his topic changed. He began to publish papers about computerized testing with various short-cut algorithms for rapid mental health assessment tools, developed with an NIMH grant. And then there was a private company to do computerized screening that he founded although it wasn’t mentioned in his early paper about his algorithms. It turned out that the company was headed by Robert Gibbons<\/font> and David Kupfer<\/font><\/strong>, who was at the time, co-chair of the DSM-5 Task Force. And in spite of Dr. Kupfer’s prior declaration that he had no Conflicts of Interest as DSM-5 Task Force co-chair, he had been pushing dimensional diagnosis<\/font><\/em>, cross-cutting parameters like depression<\/font><\/em>, since the Task Force began in 2002. And here he was secretly a co-founder of a company winding up to sell instruments for measuring, you guessed it, dimensions<\/em>.<\/font><\/strong> So…<\/div>\n