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Table 1 Comparison of research objectives, findings and conclusions in five reviews

From: Analysis of decisions made in meta-analyses of depression screening and the risk of confirmation bias: A case study

Reference Objective Findings Conclusion
Gilbody, 2001 [10] To examine the effect of routinely administered psychiatric questionnaires on the: 1. Meta-analytic pooling of 4 studies (2457 participants) which measured the effect of feedback on the recognition of depressive disorders found that routine administration and feedback of scores for all patients did not increase the overall rate of recognition of mental disorders such as anxiety and depression. The routine administration of psychiatric questionnaires with feedback to clinicians does not improve the detection of emotional disorders or patient outcome, although those with high scores may benefit.
  1. recognition, 2. 2 studies showed that routine administration followed by selective feedback for only high scorers increased the rate of recognition of depression. The widely advocated use of simple questionnaires as outcomes measures in routine practice is not supported.
  2. management, and 3. This increased recognition did not translate into increased rate of intervention.  
  3. outcome of psychiatric disorders in non­psychiatric settings 4. Overall, studies of routine administration of psychiatric measures did not show an effect on patient outcome.  
Gilbody, 2005[8] To determine the clinical effectiveness of screening and case finding instruments in improving depression: 1. According to case note entries of depression, screening/case finding instruments had borderline impact; There is substantial evidence that routinely administered case finding/screening questionnaires for depression have minimal impact on the detection, management or outcome of depression by clinicians.
  1. recognition 2. Overall trend to showing a borderline higher intervention rate amongst those who received feedback of screening/case finding instruments. This result was dependent upon presence of 1 highly positive study;  
  2. management 3. 3 out of 4 studies reported no clinical effect at either 6 or 12 months.  
3. outcome.
Gilbody, 2008 [9] To establish the effectiveness of screening in improving the 1. Use of screening or case-finding instruments were associated with a modest increase in the recognition of depression by clinicians If used alone, case-finding or screening questionnaires for depression appear to have little or no impact on the detection and management of depression by clinicians.
  1. recognition of depression, 2. Questionnaires, when administered to all patients and the results given to clinicians irrespective of baseline score, had no impact on recognition. Recommendations to adopt screening strategies using standardized questionnaires without organizational enhancements are not justified.
   3. There was no evidence of influence on the prescription of antidepressant medications.  
  2. the management of depression and 4. No evidence of an effect on outcomes of depression was found.  
3. the outcomes of patients with depression.
USPTF, 2002[12, 13] 1. What is the accuracy of case-finding instruments for depression in primary care populations? 1. Compared with usual care, feedback of depression screening results to providers generally increased recognition of depressive illness in adults. Compared with usual care, screening for depression can improve outcomes, particularly when screening is coupled with system changes that help ensure adequate treatment and follow-up.
  2. Is treatment of depression in primary care patients effective in improving outcomes? 2. Studies examining the effect of screening and feedback on treatment rates and clinical outcomes had mixed results. Many trials lacked power to detect clinically important differences in outcomes.  
  3. Is routine systematic identification with case-finding questions (screening), with or without integrated management and follow-up systems, more effective than usual care in identifying patients with depression, facilitating treatment of patients with depression, and improving clinical outcomes? 3. Meta-analysis suggests that overall, screening and feedback reduced the risk for persistent depression.  
   4. Programs that integrated interventions aimed at improving recognition and treatment of patients with depression and that incorporated quality improvements in clinic systems had stronger effects than programs of feedback alone.  
USPTF, 2009[14, 15] To review the benefits and harms of screening adult patients for depression in a primary care setting 1. Primary care depression screening and care management programs with staff assistance, such as case management or mental health specialist involvement, can increase depression response and remission. 1. The USPSTF recommends screening adults for depression when staff-assisted depression care supports are in place to assure accurate diagnosis, effective treatment, and follow-up. (Grade B recommendation)
   2. Benefit was not evident in screening programs without staff assistance in depression care. 2. The USPSTF recommends against routinely screening adults for depression when staff-assisted depression care supports are not in place. There may be considerations that support screening for depression in an individual patient. (Grade C recommendation)