Depression & anxiety screening
Recommendations
USPSTF2023Grade B
Screen all adults for depression (incl. pregnant/postpartum) and adults <65 for anxiety disorders. Use PHQ-9 / GAD-7.
Verify at USPSTF (opens in a new tab)USPSTF2022Grade B
Children and adolescents: screen for major depressive disorder at ages 12 to 18 and for anxiety at ages 8 to 18. Evidence is insufficient (I) for depression screening at 11 or younger, anxiety screening at 7 or younger, and suicide risk screening in children and adolescents.
Verify at USPSTF (opens in a new tab)ACP2023Grade Strong recommendation, moderate-certainty evidence
Moderate to severe major depressive disorder, acute phase: start either cognitive behavioral therapy or a second-generation antidepressant as monotherapy; combination therapy is a conditional option. Mild MDD: CBT first (conditional). If no response to an adequate SGA dose, switch to or add CBT, or switch SGA or augment with a second drug (conditional). Living guideline, reaffirmed through March 2026.
Verify at ACP (opens in a new tab)USPSTF2019Grade B
Provide or refer pregnant and postpartum persons at increased risk of perinatal depression to counseling (cognitive behavioral or interpersonal therapy). Increased risk includes a history of depression, current subthreshold depressive symptoms, low income, adolescent or single parenthood, recent intimate partner violence, elevated anxiety, or significant negative life events.
Verify at USPSTF (opens in a new tab)Who this applies to
- All adults 19 and older, including during pregnancy and the first year after birth (USPSTF 2023, Grade B).
- Adults 19 to 64 for anxiety disorders (Grade B). For 65 and older the evidence is insufficient (I), which is a call for judgment, not a recommendation against.
- Children and adolescents: 12 to 18 for major depressive disorder and 8 to 18 for anxiety (USPSTF 2022, Grade B).
- Screening for suicide risk in people with no signs or symptoms: insufficient evidence (I). Ask directly whenever depression is present.
How it is done in practice
- PHQ-2 first; a score of 3 or more leads to the full PHQ-9. GAD-2, then GAD-7, for anxiety. The Edinburgh Postnatal Depression Scale during and after pregnancy.
- PHQ-9 of 10 or more is the usual threshold for a probable depressive disorder. A positive item 9 (thoughts of being better off dead or of self-harm) needs same-visit follow-up whatever the total.
- Screening only counts when there is a path to diagnosis, treatment and follow-up. The 2016 recommendation made this an explicit condition, and the 2023 practice considerations repeat it.
- No fixed interval is specified. Most practices screen at least yearly and at any visit where mood, sleep or function has changed.
What changed recently
The 2023 statement added anxiety screening for adults under 65 for the first time and kept depression screening for all adults. Perinatal screening has no set timing; the USPSTF calls ongoing assessment during pregnancy and after birth reasonable. The 2016 version covered depression only.
Points that matter in clinic
- A positive screen is not a diagnosis. Confirm with a clinical interview and check for bipolar history, substance use, thyroid disease and medication effects before starting an antidepressant.
- Older adults more often present with body complaints, sleep change and slowed thinking than with sadness. The 15-item Geriatric Depression Scale is validated for them.
- Record the score at every visit so response is measurable: a drop of 5 points on the PHQ-9 is a meaningful response, and a score under 5 is remission.