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A number of screening tools exist for use in primary care settings. Asking 2 simple questions regarding mood and anhedonia—“Over the past 2 weeks, have you felt down, depressed, or hopeless?” and “Over the past 2 weeks, have you felt little interest or pleasure in doing things?”—may be as effective as longer instruments. 12, 13 The authors of the systematic review for the US task force calculated that 11 patients with depression would need to be identified through screening to produce 1 additional remission at 6 months. Assuming a 10% prevalence of treatmentresponsive depression in primary care, 110 patients would need to be screened to produce this additional clinical remission. 2 Although the optimal interval for screening is unknown, the US task force recently stated that “recurrent screening may be most productive in patients with past history of depression, unexplained somatic symptoms, comorbid psychological conditions (such as panic disorder or generalized anxiety), substance abuse, or chronic pain.” 12 A positive screen must be followed by accurate diagnosis, effective treatment and follow-up to ensure that the benefits of screening are realized.

“Integrated programs” as defined in the US and Canadian task force reviews went beyond feedback and included interventions such as education of patients or health care providers or both, access to case management or mental health care and telephone follow-up. 12 In deciding whether an integrated program of care for screening and treating depression exists in a community, clinicians need to examine the step-by-step process by which patients go from screening to receiving …