title: Systematic depression screening in high-risk patients attending primary care: a pragmatic cluster-randomized trial.
abstract: BACKGROUND
  Systematic screening for depression in high-risk patients is recommended but remains controversial. The aim of this study was to assess the effectiveness of such screening in everyday clinical practice on depression recognition.
  
  
  METHODS
  A pragmatic, cluster randomized, controlled study that randomized primary care physicians (PCPs) in Spain either to an intervention or control group. The intervention group (35-PCPs) received training in depression screening and used depression screening routinely for at least 6 months. The control group (34-PCPs) managed depression in their usual manner. Adherence to (1-6; never-very frequently), feasibility (1-4; unfeasible-very feasible), and acceptance (1-5; very poor-very good) of the screening were evaluated. Underrecognition (primary outcome) and undertreatment rates of major depressive disorder (MDD) in the two groups were compared 6 months after randomization in a random sample of 3737 patients assigned to these PCPs using logistic regression adjusting for the clustering effect.
  
  
  RESULTS
  No significant differences were found for recognition rates (58.0% vs. 48.1% intervention vs. control; OR [95%CI] 1.40 [0.73-2.68], p = 0.309). The undertreatment rate did not differ significantly either (p = 0.390). The mean adherence to depression screening was 4.4 ± 1.0 ('occasionally'), the mean feasibility was 3.1 ± 0.5 ('moderately feasible'), and the mean acceptance was 4.2 ± 0.6 ('good').
  
  
  CONCLUSIONS
  This research was not able to show effectiveness of the systematic screening for MDD in high-risk patients on depression recognition in primary care. The poor adherence to screening implementation could partially explain the results. These reflect the difficulties of putting into practice the clinical guidelines usually based on interventional research.
  
  
  BACKGROUND
  Clinicaltrials.gov NCT01662817.
authors.affiliation: Clinical Research Department, Lilly, S.A., Avenida de la Industria, 30. Alcobendas, E-28108, Madrid, Spain. romera_irene@lilly.com
authors.forename: Irene
authors.initials: I
authors.lastname: Romera
authors.forename: Ángel L
authors.initials: ÁL
authors.lastname: Montejo
authors.forename: Enric
authors.initials: E
authors.lastname: Aragonés
authors.forename: José Ángel
authors.initials: JÁ
authors.lastname: Arbesú
authors.forename: Celso
authors.initials: C
authors.lastname: Iglesias-García
authors.forename: Silvia
authors.initials: S
authors.lastname: López
authors.forename: José Antonio
authors.initials: JA
authors.lastname: Lozano
authors.forename: Sireesha
authors.initials: S
authors.lastname: Pamulapati
authors.forename: Belen
authors.initials: B
authors.lastname: Yruretagoyena
authors.forename: Inmaculada
authors.initials: I
authors.lastname: Gilaberte
mesh_terms: D003865:Major Depressive Disorder / Q000175:diagnosis*; D003951:Diagnostic Errors / Q000706:statistics & numerical data; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000379:methods*; D008875:Middle Aged; D011320:Primary Health Care / Q000379:methods*; D011569:Psychiatric Status Rating Scales; D012307:Risk Factors