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Depression screening — CCFP MCQ

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ModeratePreventive care and screeningDepression screeningCCFP

A 47-year-old man asks for a depression screening questionnaire at his annual physical examination. He has no symptoms, no past psychiatric history, and no functional concerns. He mentions that his employer suggested annual screening for all employees. What is the most appropriate screening approach for this patient?

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Correct answer: E — Do not use routine questionnaire cut-off screening; remain attentive to symptoms and concerns

The Canadian Task Force on Preventive Health Care (CTFPHC) provides a strong recommendation against routine instrument-based depression screening in asymptomatic adults at average risk. Option E best reflects this guidance: instead of routine cut-off-based questionnaires, clinicians should be vigilant and respond to any reported symptoms or emerging concerns as part of good clinical care. Option B (routine PHQ-9 for all) is not supported and may increase unnecessary diagnosis and harm. Option D (preventive SSRI) is inappropriate for someone without symptoms or risk factors. Option C (serum cortisol) is not validated or appropriate for this purpose. Option A (psychiatry referral for screening) misuses specialist resources without indication. Only option E aligns with current Canadian preventive care recommendations.

Reference: Canadian Task Force on Preventive Health Care. Recommendation on screening adults for depression using a screening tool. CMAJ. 2018;190(35):E1132–E1140. https://www.cmaj.ca/content/197/35/E1132