Depressive and bipolar disorders affect over 9% of the U.S. population. About 16 million adult Americans, or almost 7%, have major depression, often with coexisting anxiety disorders and substance abuse. Depression is nearly twice as common in women as men; the prevalence of postpartum depression is 7% to 13%. Depression frequently accompanies chronic medical illness. High-risk patients may have subtle early signs of depression, including low self-esteem, loss of pleasure in daily activities (anhedonia), sleep disorders, and difficulty concentrating or making decisions.

Look carefully for symptoms of depression in vulnerable patients, especially those who are young, female, single, divorced or separated, seriously or chronically ill, bereaved, or have other psychiatric disorders, including substance abuse. A personal or family history of depression also places patients at risk.

The U.S. Preventive Services Task Force (USPSTF) made a grade B recommendation in 2009 for depression screening in clinical settings that can provide care supports and accurate diagnosis, treatment, and follow-up. Performing screening in less upportive settings received only a grade C recommendation. Asking two simple questions about mood and anhedonia appears to be as effective as using more detailed instruments. A positive test response has a sensitivity of 83% and a specificity of 92% for detecting major depression. All positive screening tests warrant full diagnostic interviews. Failure to diagnose depression can have fatal consequences—the presence of an affective disorder is associated with an 11-fold increased risk for suicide.

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