No Evidence for Depression Screening in Rheumatoid Arthritis, Psoriasis, or Psoriatic Arthritis

To the Editor: Members of the Canadian Dermatology-Rheumatology Comorbidity Initiative recently recommended routine depression screening among patients with rheumatoid arthritis (RA), psoriasis (PsO), and psoriatic arthritis (PsA)1. Although this is described as an evidence-based recommendation, the only evidence that was presented was that patients with these conditions may have a higher prevalence of depression than people without chronic medical diseases and that 2 cohort studies have associated depression with a worse prognosis in RA. Depression screening involves administering self-report questionnaires or small sets of questions to identify patients who may have depression, but who are not already diagnosed or being treated for depression2. For a depression screening program to be successful, patients not already known to have depression must agree to be screened, a significant number of new cases must be identified with relatively few false-positive screens, and newly identified patients must engage in treatment with successful outcomes3. There are well-established criteria for evaluating when routine screening for any … Address correspondence to B.D. Thombs, Jewish General Hospital, 4333 Cote Ste Catherine Road, Montreal, Quebec H3T 1E4, Canada. E-mail: brett.thombs{at}mcgill.ca