medical screening protocols. The low-cost, potentially high-benefit strategy of screening for depression, with appropriate referrals and follow through, may ameliorate some psychologic burdens in the RECA population.4,5


This chapter has reviewed in depth the conceptual and statistical underpinnings of screening for medical purposes. We have discussed the limitations and risks of screening for diseases for which early detection offers little benefit. We have also shown how screening in low-risk populations and screening for multiple diseases will produce a substantial burden of false-positive results. Finally, we have offered several recommendations to reduce potential harms and mistakes from the use of multiple screening tests among individuals for whom the medical benefits cannot outweigh the harms and the likelihood of compensation may be low. Some recommendations are directed at agents that would need to amend RECA (or RESEP) legislation; others are directed at steps that HRSA can consider without statutory changes. The next chapter picks up on the new issue in RESEP: screening for compensable disease.


For the reasons provided in detail in this chapter concerning the potential risks of depression developing in exposed populations (about which we heard testimony from Drs. Robert Ursano and Evelyn Bromet), the seriousness of the depression in terms of morbidity and mortality from suicide, and the treatability of depression, committee members Stephen G. Pauker and Catherine Borbas find it inconsistent with good medical or public health practice merely to state that “HRSA may want to consider screening for depression” in RECA populations. It is their opinion that such screening should be “recommended,” as it is for adults in the general population (see USPSTF). Further, it is noteworthy that few, if any, current HRSA grantees have listed screening for depression in their current protocols, emphasizing the need for this specific recommendation.


Committee member Kathleen N. Lohr wishes to support a recommendation that HRSA expand its screening activities to include mental and emotional disorders (particularly major depression, generalized anxiety disorder, and post-traumatic stress disorder), following through as needed with appropriate referrals to medical and psychiatric care relevant to the diagnoses in question. The report still contains much evidence, both from the published literature and more anecdotally from the numerous presentations at the committee’s information-gathering meetings, that major and/or minor depression may well have a prevalence in these RECA populations higher than that for the general adult population. Screening for depression in adults, with the qualifications noted in the report as to the medical infrastructure needed for high-quality care, is a formal recommendation of the US Preventive Services Task Force. Numerous easy-to-use screening methods exist, and the practice of such screening is spreading (Santora and Carey, 2005).

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