Background:
Screening adolescents for depression has recently been advocated
by two major national organizations. However, this practice is not without controversy.
Objective:
To review diagnostic, clinical, and conflict of interest issues associated with the
calls for routine depression screening in adolescents.
Method:
The evaluation of depression screening by the US Preventive Services Task Force
is compared and contrasted with those of comparable agencies in the UK and Canada, and
articles arguing for and against screening are reviewed. Internal pharmaceutical industry
documents declassified through litigation are examined for conflicts of interest. A case is
presented that illustrates the substantial diagnostic limitations of self-administered mental
health screening tools.
Discussion:
The value of screening adolescents for psychiatric illness is questionable, as is
the validity of the screening tools that have been developed for this purpose. Furthermore,
many of those advocating depression screening are key opinion leaders, who are in effect
acting as third-party advocates for the pharmaceutical industry. The evidence suggests that a
commitment to marketing rather than to science is behind their recommendations, although
their conflicts of interest are hidden in what seem to be impartial third-party recommendations.
Adolescent Depression Screening: Not So Fast