Approach to depression screening

This algorithm outlines an approach to routine screening for major depressive disorder. It should be used in conjunction with UpToDate content regarding depression screening. For additional details on how to evaluate a positive screen, refer to boxes and related UpToDate content on the assessment, diagnosis, and management of unipolar depression.

* Patients who score 1 or higher on the question "Thoughts that you would be better off dead, or of hurting yourself in some way" require same day assessment for suicidal ideation and intent. This assessment should occur in conjunction with classification of the severity of depression symptoms and further diagnostic evaluation. Refer to related UpToDate content on suicidal ideation and behavior in adults for details.

¶ Most patients with mild symptoms (PHQ-9 5 to 9) will not have major depression. These patients should undergo re-assessment within 12 weeks, or sooner if symptoms worsen. Re-assessment can occur by telephone, via telehealth, or in person.

Δ Patients with severe symptoms (PHQ-9 ≥20) require same day evaluation, management, and/or referral.

References:

US Preventive Services Task Force, Barry MJ, Nicholson WK, et al. Screening for Depression and Suicide Risk in Adults: US Preventive Services Task Force Recommendation Statement. JAMA 2023; 329:2057.
McCarron RM, Shapiro B, Rawles J, Luo J. Depression. Ann Intern Med 2021; 174:ITC65.

PHQ-2 (Inset 1) and PHQ-9 (Inset 2) developed by Drs. Robert L Spitzer, Janet BW Williams, Kurt Kroenke, and colleagues, with an educational grant from Pfizer, Inc. No permission required to reproduce, translate, display or distribute.

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Approach to depression screening