Since depression is approximately two times more common in women than in men, clinicians should be alert to its symptoms in their female patients. Symptoms include depressed mood, loss of interest in activities, sleep disturbance, change in appetite or weight, psychomotor retardation, difficulty concentrating, feelings of worthlessness, and thoughts of suicide (see also Chapter 25-12). Low energy or fatigue is a particularly common symptom in women.
There are several tools for depression screening, and there is no evidence to suggest that any particular screening tool is superior. A simple two-question screen called the Patient Health Questionnaire 2 (PHQ-2) appears to be effective. Patients are asked "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?" A positive screening test should lead to more extensive evaluation, using tools such as the PHQ-9 for adults, the Geriatric Depression Scale-15 for older adults, or the Edinburgh Postnatal Depression Scale for pre- and postpartum women.
Approximately 14% of perinatal women experience depression, thus the peripartum period is a particularly important time for screening and intervention. Counseling interventions, such as behavioral therapy and interpersonal therapy, are effective at preventing perinatal depression. The USPSTF recommends offering these treatments to women at higher risk of peripartum depression, such as women with a history of depression or specific socioeconomic factors (eg, low income). The USPSTF recommends screening for depression if staff-assisted depression care supports are in place to ensure accurate diagnosis, effective treatment, and follow-up. If these supports are absent, screening is not recommended.
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