Mood disorders are a global health issue. National guidelines for their detection and management have been published in the United States and in Europe. Are these guidelines accomplishing their intended purpose of improved detection and patient outcomes? Does introducing screening for depression automatically lead to improved outcomes? How should a screening instrument be selected from the many available? How can clinicians improve their own ability to detect depression?

Alex J. Mitchell, MRCPsych, Consultant and Honorary Senior Lecturer in Liaison Psychiatry, Department of Cancer and Molecular Medicine, University of Leicester, Leicester, UK. James C. Coyne, PhD, Co-Director, Health Services and Behavioral Sciences Program, Abramson Cancer Center, The University of Pennsylvania Professor of Psychology, Department of Psychiatry, The University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania

List of Contributors	p. xi
Preface	p. xv
Is the Syndrome of Depression a Valid Concept?	p. 3
What is Meant by Depression?	p. 3
Value and Validity of the Syndrome Concept	p. 7
Diagnostic Checklists (including DSM and ICD)	p. 10
Unstructured (Unassisted) Clinician Diagnosis	p. 15
Structured and Semi-Structured Assisted Diagnostic Interviews	p. 19
Conclusion	p. 22
References	p. 24
Overview of Depression Scales and Tools	p. 29
Background	p. 29
The Classic Severity Scales (1960-1980)	p. 36
The New Severity Scales (1981-2008)	p. 39
The Future of Screening Scales	p. 44
References	p. 51
Why Do Clinicians Have Difficulty Detecting Depression?	p. 57
Introduction to the Problem of Over- and Under-Detection	p. 57
Predictors of Detection	p. 62
Patient and Clinician Influences on Detection	p. 66
Illness-Related Influences on Detection	p. 71
Conclusions	p. 74
References	p. 75
How Can Existing Mood Scales Be Improved? How to Test, Refine, and Improve Existing Scales	p. 83
Introduction	p. 83
The Rasch Model and Other Item Response Models	p. 86
Conclusion	p. 95
References	p. 96
How Do We Know When a Screening Test is Clinically Useful?	p. 99
How Do Clinicians Make a Diagnosis?	p. 99
Scientific Aspects of Diagnostic Accuracy	p. 103
Clinical Aspects of Diagnostic Accuracy	p. 105
Testing Screening via Implementation Studies	p. 109
Conclusions	p. 111
References	p. 111
Clinical Judgment and the Influence of Screening on Decision Making	p. 113
Introduction	p. 113
Research on Clinical Judgment	p. 114
The Limits of Screening	p. 119
References	p. 120
Implementing Screening as Part of Enhanced Care: Screening Alone is Not Enough	p. 123
The Case for Screening	p. 123
Screening and Enhanced Care for Depression	p. 128
New and Additional Evidence Relating to Enhanced Care	p. 128
Is Screening a Necessary Intervention to Improve the Quality and Outcome of Care?	p. 129
To Screen or Not to Screen?	p. 136
References	p. 137
Technological Approaches to Screening and Case Finding for Depression	p. 143
Technological Methods of Screening for Depression	p. 144
Ten Issues When Developing Computerized Screening for Depression	p. 147
Examples of Implementation of Computerized Screening for Depression	p. 150
Discussion	p. 153
Conclusion	p. 154
References	p. 154
Screening for Depression in Primary Care: Can It Become More Efficient?	p. 161
Introduction	p. 161
Epidemiology of Depression in Primary Care	p. 162
Is Screening for Depression in Primary Care Worthwhile?	p. 165
Which Screening Tool Should Be Used?	p. 169
Implementing Screening in Primary Care	p. 178
What Developments Are on the Horizon?	p. 183
Conclusions	p. 185
References	p. 185
Screening for Depression in Medical Settings: Are Specific Scales Useful?	p. 191
An Introductory Logic	p. 191
Depression in the Medically Ill	p. 192
"False-Positive" Depression Reflecting Confounding by Physical Symptoms Associated with Medical Illness	p. 193
Screening Measures Used to Assess Depression in the Medically Ill	p. 194
Discussion	p. 198
References	p. 199
Screening for Depression in Medical Settings: The Case Against Specific Scales	p. 203
Overview of Depression in Physical Disease	p. 203
Defining Somatic Symptoms	p. 205
Diagnostic Accuracy of Somatic Symptoms in Depression	p. 209
Evidence For and Against Somatic Symptoms when Diagnosing Comorbid Depression	p. 211
Implications for Screening	p. 217
References	p. 236
Screening for Depression in Neurologic Disorders	p. 241
Depression in Stroke	p. 242
Depression in Multiple Sclerosis	p. 246
Depression in Epilepsy	p. 249
Depression in Parkinson's Disease	p. 255
Conclusions	p. 258
References	p. 258
Screening for Depression in Cancer Care	p. 265
Prevalence of Depression in Cancer Care	p. 265
Screening Methods for Depression	p. 266
Screening for Depression in Oncology	p. 267
Implementing Screening Programs in Oncology Settings	p. 276
Special Issues in Screening Cancer Patients	p. 292
Summary, Integration, Future Directions	p. 293
Acknowledgments	p. 294
References	p. 295
Screening for Depression in Perinatal Settings	p. 299
Introduction: Perinatal Screening in Context	p. 299
Why Screen, and What Are We Screening For?	p. 301
Screening Practices in Perinatal Settings	p. 303
Screening Guidelines and Recommendations	p. 304
Evidence-Based Comparison of Screening Methods	p. 305
Implementation in Practice: Does Screening Make any Real-World Difference?	p. 310
Service Delivery and Treatment Implications	p. 311
Summary and Key Recommendations	p. 313
References	p. 314
Screening in Cardiovascular Care	p. 317
Depression in Cardiovascular Disease	p. 318
The Prevalence of Depression in Cardiovascular Disease	p. 319
Screening Instruments for Depression in Cardiovascular Care	p. 320
Recommendations for Evaluation and Treatment of Patients in Cardiovascular Care	p. 326
Conclusions	p. 328
References	p. 329
Screening in Diabetes Care: Detecting and Managing Depression in Diabetes	p. 335
Depression in Diabetes is a Major Health Problem	p. 337
Screening Tests	p. 340
Treatment Options	p. 343
Screening Program	p. 344
Conclusions for Clinical Practice	p. 345
References	p. 346
Commentary and Integration: Is it Time to Routinely Screen for Depression in Clinical Practice?	p. 349
Integration: Deflating the Puffer Phenomenon and Making the Case Against Screening	p. 364
References	p. 366
Appendix	p. 371
Index	p. 385
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