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O'Connor EA, Whitlock EP, Gaynes B, et al. Screening for Depression in Adults and Older Adults in Primary Care: An Updated Systematic Review [Internet]. Rockville (MD): Agency for Healthcare Research and Quality (US); 2009 Dec. (Evidence Syntheses, No. 75.)

Cover of Screening for Depression in Adults and Older Adults in Primary Care

Screening for Depression in Adults and Older Adults in Primary Care: An Updated Systematic Review [Internet].

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Appendix CInclusion and exclusion criteria for key questions

Key Question 1 and 1a-Screening trials

Inclusion Criteria:

  1. Screening: study of depression screening; outcomes same as those listed above.

Exclusion Criteria:

  1. Focus on inpatient, residential treatment, psychiatric, or community settings.
  2. Focus on interventions that are not primary care feasible or referable (e.g. ECT).
  3. Does not meet quality criteria, including follow-up of less than 6 weeks.
  4. Focus on children or adolescents.
  5. None of the outcomes listed above.
  6. Focus on pregnancy-related screening.
  7. Examination of genetic modifiers.
  8. Does not meet any inclusion criterion.
  9. Not a general primary care population.
  10. Not English language or non-developed country.
  11. Non-comparative study/excluded design.
  12. Comparative-effectiveness study.
  13. Missing both depression-specific screener and depression-specific outcome
  14. Use as source document.
  15. Screen not used in clinical care.

Key Question 2-Harms of screening

Inclusion Criteria:

  1. Study addressing adverse events associated with depression screening.

Exclusion Criteria:

  1. Setting limits generalizability to general adult primary care population.
  2. Focus on interventions other than antidepressants
  3. Does not meet quality criteria, including follow-up of less than 6 weeks
  4. Focus on children or adolescents.
  5. Focus on pregnancy-related screening.
  6. Examination of genetic modifiers.
  7. Does not meet any inclusion criterion.
  8. Not generalizable to primary care population
  9. Not English language or non-developed country
  10. Non-comparative study/excluded design.
  11. Use as source document

Key Question 3-Treatment with antidepressants in the elderly

Inclusion Criteria: Study of depression treatment with antidepressants in the elderly, meeting all of the following criteria:

  1. Setting: primary care, outpatient mental health, community setting if intervention is PC-feasible or referable.
  2. Intervention: antidepressant for acute treatment of depression
  3. Quality: fair-good quality per USPSTF standards, with follow-up of at least 6 weeks.
  4. Design: Meta-analysis or systematic evidence review
  5. Outcomes: depressive symptomatology, quality of life ratings, assessments of functioning, depressive illness diagnosis, suicidality (attempts or ideation), or change in health status (e.g., death, improvement in co-morbid disorders, reduction in physical complaints).
  6. Population: Exclusively or primarily (> 80%) ages 65 and older
  7. Context/Environment: Conducted in US, UK, Canada, Australia, New Zealand
  8. Language: Published in English

Exclusion Criteria:

  1. Focus on inpatient, residential treatment, psychiatric, or community settings.
  2. Focus on interventions that are not primary-care feasible or referable
  3. Does not meet quality criteria, including follow-up of less than 6 weeks
  4. Focus on children or adolescents
  5. None of the outcomes listed above.
  6. Examination of genetic modifiers
  7. Does not meet any inclusion criterion.
  8. Not a general primary care population
  9. Not English language or one of included countries
  10. Non-comparative study.
  11. Comparative-effectiveness study.
  12. Use as source document
  13. Focus on non-elderly adults.
  14. Depression prevention or treatment maintenance interventions.
  15. Not a treatment outcomes study.
  16. Article is an individual trial (rather than synthesized review), or it is a SER/MA with content area covered more comprehensively or recently in one of the Included reviews.

Key Question 3-Treatment with psychotherapy in the elderly

Inclusion Criteria: Study of depression treatment with psychotherapy in the elderly, meeting all of the following criteria:

  1. Setting: primary care, outpatient mental health, community setting if intervention is PC-feasible or referable.
  2. Intervention: cognitive-behavioral, interpersonal therapy, or problem-solving type intervention
  3. Quality: fair-good quality per USPSTF standards, with follow-up of at least 6 weeks.
  4. Design: Systematic evidence review or meta-analysis
  5. Outcomes: depressive symptomatology, quality of life ratings, assessments of functioning, depressive illness diagnosis, suicidality (attempts or ideation), or change in health status (e.g., death, improvement in co-morbid disorders, reduction in physical complaints).
  6. Population: Exclusively or primarily (> 80%) ages 65 and older
  7. Context/Environment: Conducted in US, UK, Canada, Australia, New Zealand
  8. Language: Published in English

Exclusion Criteria, any of the following:

  1. Focus on inpatient, residential treatment, psychiatric, or community settings.
  2. Focus on interventions that are not primary-care feasible or referable
  3. Does not meet quality criteria, including follow-up of less than 6 weeks
  4. Focus on children or adolescents
  5. None of the outcomes listed above.
  6. Examination of genetic modifiers
  7. Does not meet any inclusion criterion.
  8. Not a general primary care population
  9. Not English language or one of included countries
  10. Non-comparative study.
  11. Comparative-effectiveness study.
  12. Use as source document
  13. Focus on interventions that are not primarily CBT-related or IPT in nature (e.g., pharmacotherapy, reminiscence, psychodynamic)
  14. Focus on non-elderly adults.
  15. Depression prevention or treatment maintenance interventions.
  16. Not a treatment outcomes study.
  17. Article is an individual trial (rather than synthesized review), or it is a SER/MA with content area covered more comprehensively or recently in one of the Included reviews.

Key Question 4-Harms of Depression Treatment with Antidepressants

Inclusion Criteria:

  1. Systematic review, regulatory review, large cohort, or large prospective observational study addressing adverse events associated with depression treatment or screening.
  2. For studies of suicidality:
    1. Minimum n=10,000 for cohort or observational study
    2. Minimum follow-up=6 months
  3. For studies of non-suicidality harms
    1. Minimum n=1,000 for cohort or observational studies
    2. Minimum follow-up=3 months
    3. May include comparative effectiveness without control group if provides absolute rates of harms in an understudied population

Exclusion Criteria:

  1. Focus on inpatient, residential treatment, psychiatric, or community settings.
  2. Focus on interventions that are not primary care feasible or referable (e.g. ECT)
  3. Does not meet quality criteria, including follow-up of less than 6 weeks
  4. Focus on children or adolescents
  5. None of the adverse effects of interest to our review above.
  6. Focus on pregnancy-related screening.
  7. Updated/covered by another more recent MA/SR
  8. Does not meet any inclusion criterion.
  9. Not a general primary care population
  10. Not English language or non-developed country
  11. Not a study design specified above.
  12. Comparative-effectiveness study.
  13. Use as source document
  14. Use as a discussion document only.

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