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Comment & Response
March 2017

Screening for Depression Through a Glass Darkly

Author Affiliations
  • 1Department of Psychiatry, Health Sciences Center, University of New Mexico School of Medicine, Albuquerque, New Mexico
JAMA Intern Med. 2017;177(3):446-447. doi:10.1001/jamainternmed.2016.9281

To the Editor The Original Investigation in a recent issue of JAMA Internal Medicine by Olfson et al1 concerning treatment of adult depression in the United States examines Medical Expenditure Panel Surveys conducted by the Agency for Healthcare Research and Quality using US Preventive Services Task Force (USPSTF) guideline recommendations on screening adults for depression by Patient Health Questionnaire-2 (PHQ-2) scores greater than 3, as well as follow-up treatment.2 Olfson et al1 found that 7.1% to 8.4% patients who screened positive for depression did not receive treatment, and 29.8% of all patients clinically treated for depression, regardless of depression screen status, screened positive for depression, consistent with reports of undertreated major depressive disorder (MDD) and overuse of antidepressants in patients without depression.3 This study assumes that a USPSTF PHQ-2 score greater than 3 has sufficient operating characteristics to provide a surrogate measure of high MDD likelihood and to initiate treatment. However, reviewing the data raises epistemic and methodological questions that suggest USPSTF screening guidelines using open survey–derived PHQ-2 scores greater than 3 are insufficient to identify MDD and initiate treatment.