SCREENING FOR DEPRESSION IN CLINICAL PRACTICE
CONTENTS 1 IS THE SYNDROME OF DEPRESSION A VALID CONCEPT? 2 OVERVIEW OF DEPRESSION SCALES AND TOOLS 3 WHY DO CLINICIANS HAVE DIFFICULTY DETECTING DEPRESSION? 4 HOW CAN EXISTING MOOD SCALES BE IMPROVED? HOW TO TEST, REFINE, AND IMPROVE EXISTING SCALES 5 HOW DO WE KNOW WHEN A SCREENING TEST IS CLINICALLY USEFUL? 6 CLINICAL JUDGMENT AND THE INFLUENCE OF SCREENING ON DECISION MAKING 7 IMPLEMENTING SCREENING AS PART OF ENHANCED CARE: SCREENING ALONE IS NOT ENOUGH 8 TECHNOLOGICAL APPROACHES TO SCREENING AND CASE FINDING FOR DEPRESSION 9 SCREENING FOR DEPRESSION IN PRIMARY CARE: CAN IT BECOME MORE EFFICIENT? 10 SCREENING FOR DEPRESSION IN MEDICAL SETTINGS: ARE SPECIFIC SCALES USEFUL? 11 SCREENING FOR DEPRESSION IN MEDICAL SETTINGS: THE CASE AGAINST SPECIFIC SCALES 12 SCREENING FOR DEPRESSION IN NEUROLOGIC DISORDERS 13 SCREENING FOR DEPRESSION IN CANCER CARE 14 SCREENING FOR DEPRESSION IN PERINATAL SETTINGS 15 SCREENING IN CARDIOVASCULAR CARE 16 SCREENING IN DIABETES CARE: DETECTING AND MANAGING DEPRESSION IN DIABETES 17 COMMENTARY AND INTEGRATION: IS IT TIME TO ROUTINELY SCREEN FOR DEPRESSION IN CLINICAL PRACTICE? IS THE SYNDROME OF DEPRESSION A VALID CONCEPT? 1 WHAT IS MEANT BY DEPRESSION? 2 VALUE AND VALIDITY OF THE SYNDROME CONCEPT 3 DIAGNOSTIC CHECKLISTS (INCLUDING DSM AND ICD) 4 UNSTRUCTURED (UNASSISTED) CLINICIAN DIAGNOSIS 5 STRUCTURED AND SEMI-STRUCTURED ASSISTED DIAGNOSTIC INTERVIEWS 6 CONCLUSION CONTEXT DEPRESSION IS AN EVERYDAY TERM, BUT IF CLINICAL MANAGEMENT IS TO BE EMPIRICALLY BASED, THERE NEEDS TO BE A VALID AND RELIABLE DEFINITION OF THE DISORDER THAT IS DISTINCT FROM NORMAL SADNESS THE VALIDITY OF THE CONCEPT AND ALL STUDIES OF SCREENING FOR DEPRESSION ARE HAMPERED BY THE ABSENCE OF A GOLD STANDARD NEVERTHELESS, VARIOUS THOROUGH METHODS OF ASSESSMENT MAY HELP TO IMPROVE THE CLINICAL UTILITY OF OUR CONCEPT OF DEPRESSION 1 WHAT IS MEANT BY DEPRESSION? THIS BOOK IS BUILT AROUND THE PREMISE THAT MAJOR DEPRESSIVE DISORDER (MDD) EXISTS IN A WAY THAT IS RECOGNIZABLE TIME AND AGAIN BY CLINICIANS AROUND THE WORLD CONSIDERABLE EFFORT HAS BEEN EXPENDED IN DEVELOPING AND REFINING METHODS TO MEASURE DEPRESSION THIS CHAPTER TAKES A STEP BACK AND ASKS WHETHER THIS EFFORT IS BUILT UPON A SOLID FOUNDATION THIS BEGINS WITH AN IMPORTANT QUESTION: WHAT IS THE PURPOSE OF MAKING A MEANINGFUL DIAGNOSIS IN ANY FIELD OF MEDICINE? WE SUGGEST IT IS PRIMARILY TO GAIN CONSENSUS AND