Major depressive disorder is a high-prevalence condition in Australia. It is estimated that 9% of men and 14% of women aged 16–85 years have experienced at least one depressive episode in their lives, with a 12-month prevalence of 4% and 6%, respectively.¹ A depressive episode may occur in the absence of major depressive disorder (eg as a consequence of seasonal associated disorder).¹ Given that GPs provide most of all mental health care, including depression care. in Australia, it is appropriate that they use screening and case finding according to population groups as outlined in the recommendations below. This is in light of mixed evidence for the effectiveness of universal screening for major depressive disorder, depending on the context of the patient population, and the level of system support available.

Although there is evidence that depression screening instruments have reasonable sensitivity and specificity, the evidence for improved health outcomes and the cost-effectiveness of screening for depression in primary care remain unclear. There is evidence for routine screening for depression in the general adult population in the context of staff-assisted support to the GP in providing depression care, case management and coordination (eg via practice nurses).¹⁴ There is insufficient evidence to recommend routine screening in adults or adolescents where case management and coordination are not available.^2,3,14 There is insufficient evidence to recommend screening in children.⁵ Clinicians should maintain a high level of awareness for depressive symptoms in patients at high risk of depression and make appropriate clinical assessments wherever the risk is high.¹¹

Consider the use of the HEADSSS assessment tool for the assessment of depression in adolescents aged 12–18 years.

Consider using Sphere-12, the K10 anxiety and depression test, the Depression Anxiety Stress Scales (DASS) or the Depression self-report questionnaire (DMI-10 and DMI-18) for the assessment of depression in adults.¹⁵

Universal screening for depression is not recommended among Aboriginal and Torres Strait Islander peoples. Identify those people in whom the risk of depression is greater as part of annual health assessments. Consider using one of the ‘social and emotional wellbeing’ or mental health assessment tools to guide the conversation. Options include the Kessler Psychological Distress Scale (K-5), the Here and Now Aboriginal Assessment (HANAA) tool, the Patient Health Questionnaire (PHQ)-9, PHQ-9 adapted, PHQ-2 and link-me.¹⁶

Medications are not recommended for the primary prevention of depression.¹⁶

For specific recommendations and advice for Aboriginal and Torres Strait Islander people, please refer to the Prevention of depression section in the National guide to a preventive health assessment for Aboriginal and Torres Strait Islander people.