Adolescent Depression Screening: Not So Fast

Background: Screening adolescents for depression has recently been advocatedby two major national organizations. However, this practice is not without controversy. Objective: To review diagnostic, clinical, and conflict of interest issues associated with thecalls for routine depression screening in adolescents. Method: The evaluation of depression screening by the US Preventive Services Task Forceis compared and contrasted with those of comparable agencies in the UK and Canada, andarticles arguing for and against screening are reviewed. Internal pharmaceutical industrydocuments declassified through litigation are examined for conflicts of interest. A case ispresented that illustrates the substantial diagnostic limitations of self-administered mentalhealth screening tools. Discussion: The value of screening adolescents for psychiatric illness is questionable, as isthe 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 effectacting as third-party advocates for the pharmaceutical industry. The evidence suggests that acommitment to marketing rather than to science is behind their recommendations, althoughtheir conflicts of interest are hidden in what seem to be impartial third-party recommendations.