New guideline emphasizes conversations about mood, mental health between patients and clinicians

Depression is a mental illness, and support for depression can improve emotions, thoughts, and well-being. A new guideline from the Canadian Task Force on Preventive Health Care recommends that patients aged 18 and older talk to their health care providers about depression rather than undergo routine screening with standard tools, like questionnaires. The guideline is published in the Canadian Medical Association Journal.

In Canada, depression is common, with about one in 10 people (without bipolar disorder) experiencing depression in their lifetimes. It negatively affects how a person feels, thinks, or behaves and can be linked to thoughts of suicide.

Since 2012, rates of depression have risen in people aged 15 years and older. People who experienced childhood trauma, have chronic disease, are Indigenous, identify as 2SLGBTQIA+, or have substance use disorders are at higher risk of depression.

“Depression is a medical illness that can significantly affect people’s health and well-being,” said Task Force member Dr. Eddy Lang, an emergency physician at the University of Calgary and chair of the guideline working group.

“It is important for clinicians to be vigilant and ask about their patients’ mental health as part of usual care, and for patients to understand the importance of talking about mental health with their health care providers.”

As depression is often diagnosed, managed, and treated in primary care, the guideline is targeted at physicians, nurses, and other health professionals who may be the first point of contact for care. Its aim is to provide guidance to clinicians for adults aged 18 years and older at normal risk of depression as well as those at higher risk due to childhood trauma, family history, and other factors.

The guideline does not apply to people with a history of depression, diagnosis or symptoms of depression, or other mental illnesses.

The Canadian Task Force on Preventive Health Care recommends against routine screening for depression using standardized tools like questionnaires in all adults aged 18 years and older. Instead, it emphasizes clinical vigilance and discussions about mental health between patients and their health care providers.

“The task force did not find evidence that taking a blanket approach and screening every adult for depression with a questionnaire would lead to better mental health,” said Dr. Brett Thombs, a clinical expert on the guideline and Canada Research Chair and professor in the Faculty of Medicine at McGill University and the Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, Quebec.

“It would, though, require massive resources to do this in our health clinics, and we need those resources to help reduce the substantial challenges that people who want help face when accessing mental health care in Canada.

“The task force wisely recommended awareness and conversations between patients and their health care providers but not a screening intervention that would place additional burden on the health care system without benefit.”

In making this recommendation, the task force considered the challenges facing Canada’s primary health care system, and the burden of engaging in activities that consume scarce resources or might limit access to primary care providers, especially when there is a lack of effectiveness above usual care.

“It is important for patients to understand the value of talking about mental health with their health care providers, and we hope this guideline provides a path for clinicians to support their patients,” said Dr. Lang.

The guideline working group included three external clinical and content experts; a researcher with expertise in mental health and depression screening; a physician–scientist expert in psychiatry, including depression management in primary care; and another psychiatrist with expertise in the prevalence of mental health disorders and risk factors.

The working group also engaged members of the public who have experienced depression or are in the target group for input. Many interest holders also provided input into the guideline.