USPSTF Recommendations on Screening for MDD, Suicide Risk in Adults

The US Preventive Services Task Force (USPSTF) has recommended that adults—including those pregnant and postpartum—be screened for depression. Its recommendation addressed the need for diagnosing major depressive disorder (MDD) in the adult population.¹

MDD is a common mental health disorder in the United States that substantially impacts the lives of those affected. If MDD is left untreated in patients, it can interfere with daily function. Further, depression is common in postpartum and pregnant persons, which can lead to the risk of preterm birth and low birth weight during pregnancy and interference with parent-infant bonding postpartum.

The recommendations made by the USPSTF are meant to replace the 2014 USPSTF recommendation statement on screening for suicide risk in adults and the recommendation statement made in 2016 regarding the screening for MDD in adults.

In a separate recommendation, the USPSTF recommended that clinicians screen adults aged 19 to 64 years of age for anxiety disorders, including those who are pregnant and postpartum.

To determine its recommendation on screening for depression and suicide risk for adults, the USPSTF commissioned a systematic review that evaluated the benefits and harms of screening, the accuracy of screening, and the “benefits and harms of treatment of MDD and suicide risk in asymptomatic adults that would be applicable to primary care settings.”

Although the USPSTF found there was a moderate net benefit to screening for MDD in adults, evidence remains insufficient on the benefits and harms of screening for suicide risk in adults.

In an accompanying editorial², Gregory E. Simon, MD, MPH, noted that the USPSTF’s lack of evidence supporting a recommendation on suicide risk screening may be met with some objection.

“The finding that evidence is insufficient to recommend for or against screening for suicide risk will likely meet objections,” wrote Simon. “Improved identification of suicide risk is recommended by the Surgeon General’s office, advocacy organizations, and accreditation bodies.”

Further, he offers how clinicians can screen for suicide risks and evidence that supports the benefits of doing so.

“The key questions addressed by the USPSTF evidence review could be reframed: Do either suicidal ideation reported on depression screening questionnaires or risk scores computed from health records data accurately predict subsequent suicidal behavior? Does clinical intervention for people identified either by screening questionnaires or by risk scores reduce risk of subsequent suicidal behaviors?” wrote Simon.

Reference:

1. US Preventive Services Task Force. Screening for depression and suicide risk in adults. JAMA. Published online June 20, 2023. doi:10.1001/jama.2023.9297
2. Simon GE, Richards JE, Whiteside U. Reframing the key questions regarding screening for suicide risk. JAMA. Published online June 20, 2023. doi:10.1001/jama.2023.7241