Screening for depression and suicide risk in adults: A Draft Update of the Systematic Review Adapted from the USPSTF Review for the Japan Preventive Services Task Force

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Background: Depression and suicide-related outcomes in adults are major public health concerns. Although the U.S. Preventive Services Task Force recommends depression screening in adults, evidence for suicide risk screening remains insufficient, and the applicability of international evidence to Japan is uncertain.
Methods: This systematic review updated and adapted the 2023 USPSTF evidence review for the Japan Preventive Services Task Force. PubMed and the Cochrane Library were searched for studies published on or after September 8, 2022, and Ichushi-Web was searched without restriction by publication year. We assessed the benefits and harms of screening, the accuracy of screening instruments, and the benefits and harms of psychological and pharmacological treatments. Findings were synthesized qualitatively.
Results: Eighteen studies were included. One pragmatic randomized trial found that portal-based population health screening increased screening completion and mental health referrals but did not assess depression symptoms or other patient-important outcomes. One diagnostic accuracy study found that the DESY-PC had higher overall accuracy and sensitivity than the PHQ-9 at the evaluated cutoffs, although positive predictive values were similar. No study met the eligibility criteria for screening-related harms. Sixteen randomized trials evaluated treatment benefits, and 11 reported treatment-related harms. Psychological interventions produced heterogeneous findings, whereas four established antidepressants improved short-term depressive symptoms. Adverse events were more frequent with several antidepressants, but serious events and treatment discontinuation were uncommon during short follow-up.
Conclusions: Portal-based outreach may increase depression screening and referral, but direct evidence that screening improves patient-important outcomes remains limited. Effective implementation in Japan would require validated instruments and integrated systems for diagnostic assessment, treatment, follow-up, and crisis response. Evidence remains insufficient to determine the balance of benefits and harms of routine suicide risk screening in adults.