Depression Screening for a 35-Year-Old
For a 35-year-old patient, depression screening should be conducted using two simple questions about mood and anhedonia, followed by the PHQ-9 if positive, with appropriate systems in place for diagnosis, treatment, and follow-up. 1
Initial Screening Approach
Two-Question Screen
- Ask these two questions:
- "Over the past 2 weeks, have you felt down, depressed, or hopeless?"
- "Over the past 2 weeks, have you felt little interest or pleasure in doing things?" 1
- This brief screening is as effective as longer instruments and serves as an excellent first step 1
Follow-Up for Positive Screens
- If either question is answered positively, administer the PHQ-9 questionnaire 2
- The PHQ-9 has good sensitivity (78%) and excellent specificity (87%) at the standard cutoff score of 10 3
- The PHQ-9 provides information on both depression severity and diagnostic criteria, making it the best available depression screening tool for primary care 4
Diagnostic Assessment
- All positive screening results should trigger a full diagnostic interview using standard DSM criteria to confirm the diagnosis 1
- Assess:
- Presence of specific depressive disorders (major depression or dysthymia)
- Severity of depression
- Comorbid psychological problems (anxiety, panic attacks, substance abuse) 1
- Impact on daily functioning
Systems-Based Approach
- Critical point: Clinical practices that screen for depression must have systems in place to ensure positive screening results are followed by accurate diagnosis, effective treatment, and careful follow-up 1
- Benefits from screening are unlikely to be realized unless such systems are functioning well 1
- Staff-assisted depression care supports significantly improve outcomes 1, 5
Treatment Considerations
- Treatment may include:
- Antidepressants
- Specific psychotherapeutic approaches (cognitive-behavioral therapy, brief psychosocial counseling)
- Combination of both 1
- For adults aged 35, consider both medication and psychotherapy options based on patient preference and clinical presentation 1
Follow-Up Screening
- The optimal interval for screening is unknown 1
- Consider more frequent screening for patients with:
- History of depression
- Unexplained somatic symptoms
- Comorbid psychological conditions (panic disorder, generalized anxiety)
- Substance abuse
- Chronic pain 1
Common Pitfalls to Avoid
- False positives: About 24-40% of patients who screen positive will have major depression; others may have dysthymia, subsyndromal depression, or comorbid disorders 1
- Inadequate follow-up: Screening without proper follow-up systems in place may not improve outcomes 1
- Relying solely on screening tools: Diagnosis should combine screening tools with clinical interviews and information from other sources 1
- Missing comorbidities: Always assess for comorbid conditions that may complicate treatment 1
The PHQ-9's high diagnostic accuracy (sensitivity 0.85, specificity 0.85 with semi-structured interview reference standard) makes it an excellent tool for identifying depression in primary care settings 6, and its brevity makes it practical for routine use in busy clinical environments.