Common Mental Disorders Depression - New Zealand Doctor

Chapter 5 Recognition and assessment of common mental disorders in adults/pakeke
As whänau/family involvement does not necessarily constitute support, 203 all patients
need the opportunity to advise who they would like to be present and how much
information they want to be shared with others. 151
5.2 Targeted screening of high-risk groups
Targeted screening: evidence review
Evidence was sought on screening for common mental disorders in primary care.
Screening is defined as administering a tool to identify common mental disorders
to a complete population of adults/pakeke presenting in primary care.
Thirteen randomised controlled trials (RCTs) evaluated screening for common mental
disorders among adults in a primary care setting. Nine of the RCTs were included
in a Cochrane systematic review (2005) 288 and four had been published since. 289-292
The studies addressed depressive disorders with or without anxiety (n=11), alcohol
problems (n=1), 291 and a range of mental disorders, including somatisation and
alcohol abuse (n=1). 290 These studies found no evidence of any benefit associated
with routinely screening unselected adults in primary care, except as part of a more
comprehensive programme aiming to improve care. 288,290,291
However, there was evidence that targeted screening of selected high-risk adults
increased the identification rate of common mental disorders in adults in primary care 290
and that it also increased the likelihood of general practitioner intervention. 289,293,294
In the relevant literature, ‘high-risk’ adults were defined as those who had previously
scored high on a mental health screening questionnaire. There was insufficient evidence
to show that such identification led to significantly better clinical outcomes overall.
Targeted screening: issues for evidence-based
practice
The evidence supports targeted screening of high-risk patients in primary care (see
Box 5.1: Screening for Common Mental Disorders in Primary Care). High prevalence
groups include people with long-term disabling conditions, multiple disorders or a
past history of mental disorder. 34,295 Prevalence is also high in Mäori, particularly
Mäori women. 2 Screening is also indicated in new patients and those infrequently
seen, as mental disorders are less likely to be identified in patients with whom the
practitioner is not familiar. 2
Evidence is lacking on the optimum frequency of screening. A UK report 296 supports
screening people with coronary heart disease or diabetes for depression as part of
their routine annual check. The Guideline Development Team (GDT) notes that the
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