Meijer, A., Roseman, M., Milette, K., Coyne, J.C., Stefanek, M.E., Ziegelstein, R.C., . . . Thombs, B.D. (2011). Depression screening and patient outcomes in cancer: A systematic review. PloS One, 6(11), e27181.

To evaluate, by means of a systematic review, whether evidence supports systematic screening for depression as part of cancer care

• Databases searched were CINAHL, Cochrane Database, EMBASE, Institute of Science Index (ISI), MEDLINE, PsycINFO, Scopus, Google Scholar, Clinical Trials.gov, International Standard Randomised Control Trial Number Register
• Authors did not specify search keywords.
• Studies were included if they compared a depression-screening instrument to a valid criterion for major depressive disorder (MDD), they were randomized clinical trials (RCTs) that compared depression treatment with placebo or usual care, or they were an RCT that  assessed the effect of screening on depression outcomes. Eligible articles included studies in any language on cancer patients with any type of malignancy at any disease stage that reported original data.
• Studies were excluded if they were part of a case series or were case reports.

• Investigators retrieved a total of 2,302 studies.
• Two investigators independently reviewed articles. Consensus resolved discrepancies.
• Investigators asked three questions: What was the accuracy of the depression-screening instruments? Does treatment of depression improve depression symptoms? Is depression screening more effective than usual care in reducing depression symptoms? Specific inclusion criteria varied according to question. Studies reporting on the same sample were considered one study. Results were broken down by question.    
   

• The final number of studies included in analysis was 20.
• For question 1, the median sample size was 128; for question 2, 200; for question 3, 0. The sample range across samples was, for question 1, 16–381; for question 2, 200; for question 3, 0.
• The sample included 8 studies of breast cancer and 11 with a mixed-cancer diagnosis.
• Mean patient age was 57 years.
• Overall, 30% of participants were male and 70% were female.

• In regard to question 1: Six studies measured depression by means of the Hospital Anxiety and Depression Scale (HADS), using a cutoff of 15–20. Nine studies employed the HADS Depression Subscale, using a cutoff of 5–11. Three studies had predefined cutoff scores. HADS was the only screening tool used in more than one study. Seventeen of 19 studies did not exclude patients with current depression treatment or diagnosis.
• In regard to question 2: One RCT compared usual care versus a nurse-delivered collaborative care intervention. The trial comprised 10 one-to-one sessions over three months (the mean number of sessions completed was seven). Postintervention scores were lower in the treatment group than the scores in the usual-care group.
• In regard to question 3: No studies were eligible for analysis.
• In a high-quality RCT, a nurse-led collaborative intervention to facilitate depression care improved depression outcomes more than did usual care.

Data from this analysis do not support the hypothesis that screening for depression improves depression-related outcomes.

More work is needed to determine how screening directly or indirectly affects depression-related outcomes. All patients should have access to depression care from a multidisciplinary team.