Recommendation grades [A-E, I] and levels of evidence [I, II-1, II-2, II-3, III, good, fair, poor] are indicated after each recommendation. Definitions for these grades and levels are provided at the end of the "Major Recommendations" field.

The Canadian Task Force on Preventive Health Care (CTFPHC) concludes that there is fair evidence to recommend screening adults in the general population for depression in primary care settings that have integrated programs for feedback to patients and access to case management or mental health care (B recommendation). (Pignone et al., 2002 [I, good]; Katzelnick et al., 2000 [I, good]; Rost et al., 2001 [I, good]; Wells et al., 2000 [I, good])

The CTFPHC concludes that there is insufficient evidence to recommend for or against screening adults in the general population for depression in primary care settings where effective follow-up and treatment* are not available (I recommendation). (Pignone et al., 2002 [I, good])

The CTFPHC concludes that there is insufficient evidence to recommend for or against screening for depression among children or adolescents in primary settings (I recommendation). (Pignone et al., 2002 [I, good])

* "Effective follow-up and treatment" refers to screening programs that are integrated with both feedback to the clinician regarding depression status, as well as a system for managing treatment (antidepressant medications and psychotherapeutic interventions). Trials that included access to case management or mental health care as part of the system of care were particularly effective in reducing depressive symptoms. Since integrated screening and feedback/treatment systems are not the norm in Canadian primary care practice, clinicians are encouraged to advocate for these.

Definitions:

Levels of Evidence

Research Design Rating

I: Evidence from randomized controlled trial(s)

II-1: Evidence from controlled trial(s) without randomization

II-2: Evidence from cohort or case-control analytic studies, preferably from more than one centre or research group

II-3: Evidence from comparisons between times or places with or without the intervention; dramatic results from uncontrolled studies could be included here

III: Opinions of respected authorities, based on clinical experience; descriptive studies or reports of expert committees

Quality Rating

Good: A study (including meta-analyses or systematic reviews) that meets all design-specific criteria* well

Fair: A study (including meta-analyses or systematic reviews) that does not meet (or it is not clear that it meets) at least one design-specific criterion* but has no known "fatal flaw"

Poor: A study (including meta-analyses or systematic reviews) that has at least one design-specific* "fatal flaw", or an accumulation of lesser flaws to the extent that the results of the study are not deemed able to inform recommendations

*General design-specific criteria are outlined in Harris RP, Helfand M, Woolf SH, Lohr KN, Mulrow CD, Teutsch SM, Atkins D. Current Methods of the U.S. Preventive Services Task Force: A Review of the Process. Am J Prev Med 2001;20(suppl 3):21-35.

Recommendations Grades for Specific Clinical Preventive Actions

A: The Canadian Task Force (CTF) concludes that there is good evidence to recommend the clinical preventive action.

B: The CTF concludes that there is fair evidence to recommend the clinical preventive action.

C: The CTF concludes that the existing evidence is conflicting and does not allow making a recommendation for or against use of the clinical preventive action; however, other factors may influence decision-making.

D: The CTF concludes that there is fair evidence to recommend against the clinical preventive action.

E: The CTF concludes that there is good evidence to recommend against the clinical preventive action.

I: The CTF concludes that there is insufficient evidence (in quantity and/or quality) to make a recommendation; however, other factors may influence decision-making.

None provided

Maneuver: Screening adults in the general population for depression in settings with integrated feedback and treatment systems

• Level of Evidence: I, good to fair (four randomized controlled trials [RCTs])

Maneuver: Screening adults in the general population for depression in settings without integrated feedback and treatment systems

• Level of Evidence: I, good (systematic review of RCTs)

Maneuver: Screening children and adolescents in the general population for depression

• Level of Evidence: I, good (systematic review of RCTs)

Not applicable: The guideline was not adapted from another source.

2005 Jan

Canadian Task Force on Preventive Health Care - National Government Agency [Non-U.S.]

The Canadian Task Force on Preventive Health Care (CTFPHC) is funded through a partnership between the Provincial and Territorial Ministries of Health and Health Canada.

Canadian Task Force on Preventive Health Care (CTFPHC)

Primary Authors: Harriet L. MacMillan, Professor, Departments of Psychiatry and Behavioural Neurosciences and of Pediatrics, Offord Centre for Child Studies, McMaster University; Christopher J.S. Patterson, Professor, Division of Geriatric Medicine, Department of Medicine, R.S. McLaughlin Centre for Research and Education in Aging and Health, McMaster University; C. Nadine Wathen, Research Fellow, Department of Psychiatry and Behavioral Neurosciences, Offord Centre for Child Studies, McMaster University, Hamilton, Ont

Chair: Dr. John W. Feightner, Professor, Department of Family Medicine, The University of Western Ontario, London, Ont

Vice-Chair: Dr. Harriet MacMillan, Professor, Departments of Psychiatry and Behavioural Neurosciences and of Pediatrics, Offord Centre for Child Studies, McMaster University, Hamilton, Ont

Members: Drs. Paul Bessette, Professeur titulaire, Département d'obstétrique-gynécologie, Université de Sherbrooke, Sherbrooke, Que.; R. Wayne Elford, Professor Emeritus, Department of Family Medicine, University of Calgary, Calgary, Alta.; Denice S. Feig, Associate Professor, Departments of Medicine, of Obstetrics and Gynecology, and of Health Policy Management and Evaluation, University of Toronto, Toronto, Ont.; Joanne Langley, Associate Professor, Departments of Pediatrics and of Community Health and Epidemiology, Dalhousie University, Halifax, NS; Valerie A. Palda, Assistant Professor, Departments of Medicine and of Health Policy Management and Evaluation, University of Toronto, Toronto, Ont.; Christopher Patterson, Professor, Division of Geriatric Medicine, Department of Medicine, McMaster University, Hamilton, Ont.; Bruce A. Reeder, Professor, Department of Community Health and Epidemiology, University of Saskatchewan, Saskatoon, Sask

Resource Staff: Ruth Walton, Research Associate, Canadian Task Force on Preventive Health Care, Department of Family Medicine, The University of Western Ontario, London, Ont

Harriet MacMillan was supported by the Wyeth Canada CIHR Clinical Research Chair in Women's Mental Health.

None available

This NGC summary was completed by ECRI on August 10, 2005. The information was verified by the guideline developer on August 25, 2005. This summary was updated by ECRI Institute on November 9, 2007, following the U.S. Food and Drug Administration advisory on Antidepressant drugs.