Minimalist Approach To Depression Doesn’t Deliver

A just published study in Lancet Psychiatry shows that just screening people for depression  using a PHQ-9 score of 10 or more, doesn’t help the patient, whether or not they and/or their GP are informed. A month after baseline, PHQ9 scores in all groups reduced by 4 points  and remained at this level in follow-up. 

Based on a diagnostic interview only a third of the sample met DSM diagnostic criteria at follow up. But in NHS Talking Therapies, a PHQ-9  score of 10 or more would usher people along a depression treatment pathway. This study indicates that two out of three people would have been directed along the wrong path. Watchful waiting is called for, oftentimes there is just a passing crisis in a person’s life.   Clients need comprehensive assessment, monitoring and treatment. NHS Talking Therapies’ simple dichotomy of low and high intensity interventions is not fit for purpose.

A screen by itself is simply a ‘scream’

Interestingly in the feedback to GPs ( the study took place in Germany) they were told  that ‘a diagnosis cannot be made on the basis of the screening score alone’ and there was a ‘recommendation for further assessment and treatment for any depressive disorders that might be present’. NHS Talking Therapies clinicians are not informed of the need for a thorough going assessment.  There is no diagnosis-informed care. The Service expects clinicians to  continue to work in the dark. Only a quarter of the sample received psychotherapy or an antidepressant.

Dr Mike Scott