GREENFIELD, REIZES, MAGRUDER, ET AL. DEPRESSION SCREENING EFFECTIVENESS Am J Psychiatry 154:10, O ctober 1997 Effectiveness of Community-Based Screening for Depression Shelly F. Greenfield, M.D., M.P.H., Joelle Meszler Reizes, M.A., Kathryn M. Magruder, M.P.H., Ph.D., Larry R. Muenz, Ph.D., Barbara Kopans, B.A., and Douglas G. Jacobs, M.D. O bjective: The effectiveness of a voluntary depression screening program was assessed by determining 1) whether participants in the 1994 National Depression Screening Day went for recommended follow-up examinations and 2) the characteristics that differentiated those who did and did not return. Method: Randomly selected participants (N=1,169) from 99 facilities completed a follow-up telephone survey. Results: Of 805 people for whom follow-up was recommended, 56.5% (N=455) went for an appointment. The severity of depressive symptoms in these subjects ranged from severe (33.4% , N =152) and marked (41.3% , N =188) to minimal (17.1%, N=78) and normal (8.1%, N=37). Subjects with marked or severe depression were more likely to respond to the screening recommendation than were those with minimal de- pressive symptoms. However, at each level of symptom severity, subjects who had received previous treatment were more likely to adhere to the screening recommendation than were those with no previous treatment. Of those who returned for a recommended follow-up, 72.1% were diagnosed with depression. Of those who did not return, 29.5% cited lack of insurance, underinsurance, or inadequate finances, and 38.0% felt they could “handle” de- pression on their own. Conclusions: Voluntary screening for depression is an effective way to bring certain untreated depressed individuals to treatment. Inadequate insurance and the belief that individuals can manage depression on their own continue to be barriers to seeking treat- ment among some depressed individuals who attend a depression screening program. (Am J Psychiatry 1997; 154:1391–1397) D epression is a highly prevalent psychiatric disor- der. According to the National Institute of Men- tal Health (NIMH) Epidemiologic Catchment Area study, the 1-year prevalence of unipolar major depres- sion in adults is 5.0% (1), and the National Comorbid- ity Study found that the 1-year prevalence of major de- pression is 10.3% (7.7% in male and 12.9% in female subjects) (2). In spite of this prevalence, and the fact that depression carries with it significant morbidity and mortality (3–5), 55% of individuals with a depressive disorder have not had treatment for the disorder in the previous 12 months (1). Some possible explanations for the undertreatment of this disorder include lack of rec- ognition by nonpsychiatric health care workers (6), lack of recognition and understanding of the symptoms by the individuals themselves, reluctance to seek treat- ment because of stigma, and problems with cost and access to mental health care (7, 8). Screening for a variety of medical disorders has be- come routine (9). However, not all disorders are appro- priate for screening. Key indications for employing a screening test are that it is not outwardly evident to the individual that he or she suffers from the disease, the disease is treatable and prevalent in the population, and that initiation of treatment early in the course of the disorder will make a difference in the outcome (7). In addition, there must be a screening test with good per- formance characteristics (e.g., sensitivity and specific- ity), and the cost of the screening must not be too high (7). Furthermore, the costs of misidentification (false negative and false positive results) must not be too bur- densome to the individual or health care system (10). A number of physical conditions meet these criteria Presented in part at the 149th annual meeting of the American Psy- chiatric Association, New York, May 4–9, 1996. Received Aug. 13, 1996; revision received Jan. 23, 1997; accepted April 11, 1997. From the University of Pennsylvania, Philadelphia; NIMH, Rockville, Md.; Consolidated Department of Psychiatry, Harvard Medical School, Boston; and McLean Hospital. Address reprint requests to Dr. Green- field, McLean Hospital, 115 Mill St., Belmont, MA 02178. Supported in part by National Institute on Drug Abuse grants DA- 09400 and DA-07252; National Institute on Alcohol Abuse and Al- coholism grant AA-09881; the Dr. Ralph and Marian C. Falk Medical Research Trust; and an unrestricted educational grant from Eli Lilly and Company. The authors thank Lisa Vagge for her assistance in the preparation of this manuscript. Am J Psychiatry 154:10, October 1997 1391