TY - JOUR
AU - Y. M. Bayer
AU - T. Dadon
AU - E. Schreiber
A1 - 
AB - BACKGROUND: Major depressive disorder (MDD) in U.S. adults is common, disabling, and costly. Screening is recommended when follow-up is available, yet uptake remains uneven, and digital tools raise governance risks. AIMS OF THE STUDY: To synthesize U.S. evidence on depression burden, screening uptake, and test performance, and the clinical and economic value of early detection linked to structured follow-up, including digital and AI-based approaches. METHODS: Systematic review guided by PRISMA 2020 (2000 through March 2025) across four databases and U.S. reports; dual screening and descriptive synthesis using predefined inclusion criteria and standardized extraction templates were conducted independently. RESULTS: From 3,224 records, 112 studies were included. Depression prevalence reached 8.3 percent in adults and over 20 percent in young adults by 2022. While primary care screening rates vary (48 to 60 percent), PHQ-9 performance remains robust (88 percent sensitivity and specificity). Linking screening to collaborative care doubled remission rates (from 18 to 40 percent), cut hospitalizations by 20 percent, and reduced missed workdays from 9 to 4. Economically, integrated care is highly efficient (ICER: 15,000 to 35,000 dollars per QALY) with a 5 to 1 ROI in older adults. Digital tools reduce costs but face over 40 percent attrition; passive sensing shows high accuracy (0.89) but remains limited by privacy concerns. DISCUSSION: Value concentrates where systems deliver timely follow-up, treatment initiation, and monitoring; screening without capacity yields limited benefit. Limitations include heterogeneous comparators, model dependence on adherence and fidelity, and privacy, bias, and equity risks for digital tools. IMPLICATIONS FOR HEALTH CARE PROVISION AND USE: Standardize PHQ 2 then PHQ 9 workflows with EHR and portal automation, clear follow-up timelines, and stepped-care escalation. IMPLICATIONS FOR HEALTH POLICIES: Tie incentives to screening plus documented follow-up, support under-served settings, and require privacy and bias-monitoring standards for digital screening. IMPLICATIONS FOR FURTHER RESEARCH: Run pragmatic payer-specific evaluations and head-to-head cost-utility comparisons of digital versus questionnaire-based screening with longer follow-up and equity endpoints.
AD - Department of Health Policy and Management, Ben Gurion University of the Negev and Be'erot, Beer Sheva Mental Health Center, Beer Sheva and Achva Academic College, Beer Tuvia, Israel.
AN - 41885528
BT - J Ment Health Policy Econ
C5 - Financing & Sustainability; HIT & Telehealth
CP - 1
DA - Mar 1
DP - NLM
IS - 1
JF - J Ment Health Policy Econ
LA - eng
N2 - BACKGROUND: Major depressive disorder (MDD) in U.S. adults is common, disabling, and costly. Screening is recommended when follow-up is available, yet uptake remains uneven, and digital tools raise governance risks. AIMS OF THE STUDY: To synthesize U.S. evidence on depression burden, screening uptake, and test performance, and the clinical and economic value of early detection linked to structured follow-up, including digital and AI-based approaches. METHODS: Systematic review guided by PRISMA 2020 (2000 through March 2025) across four databases and U.S. reports; dual screening and descriptive synthesis using predefined inclusion criteria and standardized extraction templates were conducted independently. RESULTS: From 3,224 records, 112 studies were included. Depression prevalence reached 8.3 percent in adults and over 20 percent in young adults by 2022. While primary care screening rates vary (48 to 60 percent), PHQ-9 performance remains robust (88 percent sensitivity and specificity). Linking screening to collaborative care doubled remission rates (from 18 to 40 percent), cut hospitalizations by 20 percent, and reduced missed workdays from 9 to 4. Economically, integrated care is highly efficient (ICER: 15,000 to 35,000 dollars per QALY) with a 5 to 1 ROI in older adults. Digital tools reduce costs but face over 40 percent attrition; passive sensing shows high accuracy (0.89) but remains limited by privacy concerns. DISCUSSION: Value concentrates where systems deliver timely follow-up, treatment initiation, and monitoring; screening without capacity yields limited benefit. Limitations include heterogeneous comparators, model dependence on adherence and fidelity, and privacy, bias, and equity risks for digital tools. IMPLICATIONS FOR HEALTH CARE PROVISION AND USE: Standardize PHQ 2 then PHQ 9 workflows with EHR and portal automation, clear follow-up timelines, and stepped-care escalation. IMPLICATIONS FOR HEALTH POLICIES: Tie incentives to screening plus documented follow-up, support under-served settings, and require privacy and bias-monitoring standards for digital screening. IMPLICATIONS FOR FURTHER RESEARCH: Run pragmatic payer-specific evaluations and head-to-head cost-utility comparisons of digital versus questionnaire-based screening with longer follow-up and equity endpoints.
PY - 2026
SN - 1091-4358 (Print); 1099-176x
SP - 3
EP - 14+
ST - Unveiling the Value of Early Depression Screening in U.S. Adults: A Systematic Review of Clinical Benefits and Economic Returns
T1 - Unveiling the Value of Early Depression Screening in U.S. Adults: A Systematic Review of Clinical Benefits and Economic Returns
T2 - J Ment Health Policy Econ
TI - Unveiling the Value of Early Depression Screening in U.S. Adults: A Systematic Review of Clinical Benefits and Economic Returns
U1 - Financing & Sustainability; HIT & Telehealth
VL - 29
VO - 1091-4358 (Print); 1099-176x
Y1 - 2026
ER -