Summary

USPSTF 2023 recommends screening all adults ≥19 years, including pregnant/postpartum persons and older adults ≥65, for major depressive disorder (Grade B). Evidence remains insufficient to recommend for or against routine suicide risk screening in asymptomatic adults (I statement). Recommendation is consistent with prior 2016 (depression) and 2014 (suicide) statements; screening must be coupled with systems to ensure diagnosis, treatment, and follow-up.

Key Recommendations

Screen all adults ≥19 years, including pregnant and postpartum persons and older adults ≥65, for major depressive disorder (Grade B).
Do not perform routine suicide risk screening in asymptomatic adults; evidence is insufficient (I statement) — use clinical judgment.
Use validated tools: PHQ (any version) or CES-D for general adults, EPDS for perinatal persons, GDS for older adults.
Confirm all positive screens with further diagnostic assessment for depression severity and comorbid psychological conditions.
Treat MDD with antidepressant pharmacotherapy, psychotherapy (e.g., CBT), or both; consider collaborative care models.
In pregnant/breastfeeding patients, weigh the unique perinatal balance of benefits and harms when selecting pharmacologic vs psychotherapy treatment.
Ensure adequate systems for diagnosis, treatment, and follow-up are in place before implementing screening — be aware of the FDA boxed warning for SSRIs.
No optimal screening interval is established; pragmatic approach is to screen those not previously screened and re-screen based on risk factors, comorbidities, and life events.
Continue ongoing depression risk assessment throughout pregnancy and the postpartum period (first 12 months).
Screen for depression in all adults regardless of risk factors, but be aware of higher risk in women, young adults, multiracial individuals, and Native American/Alaska Native persons.

Thresholds & Doses

Adult age cutoff for this recommendation: ≥19 years.
Older adult definition: ≥65 years.
Postpartum period definition: first 12 months after delivery.
MDD DSM-5 definition: ≥2 weeks of persistent sadness or anhedonia plus associated symptoms.
PHQ-9 standard cutoff ≥10: sensitivity 0.85, specificity 0.85 for major depression.
PHQ-2 standard cutoff ≥2: sensitivity 0.91, specificity 0.67.
EPDS cutoffs 11–12: sensitivity 81–90%, specificity 83–88%.
GDS-15 cutoff ≥5: sensitivity 0.94, specificity 0.81.
SSRI-associated suicide attempt risk in adults ≤65: ~0.7% antidepressant users vs 0.3% placebo (OR 1.53).

Citations

Recommendation Summary table — Grade B for depression screening; I statement for suicide risk screening.
Practice Considerations: Patient Population — applies to adults ≥19, including pregnant/postpartum and ≥65.
Practice Considerations: Screening Tests — PHQ, CES-D, EPDS, GDS as recommended instruments.
Practice Considerations: Screening Intervals — no established optimal interval; pragmatic approach.
Practice Considerations: Treatment — psychotherapy and/or pharmacotherapy; collaborative care model.
Supporting Evidence: Accuracy of Screening Tests — PHQ-9, PHQ-2, EPDS, GDS-15 sensitivity/specificity figures.
Supporting Evidence: Harms — SSRI serious adverse events OR 1.39; suicide attempt OR 1.53 in adults ≤65.
Update of Previous USPSTF Recommendations — replaces 2014 suicide and 2016 depression statements.