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Table 3 Characteristics of randomized controlled trials described in CTFPHC, UKNSC, and USPSTF guidelines

From: Consistency and sources of divergence in recommendations on screening with questionnaires for presently experienced health problems or symptoms: a comparison of recommendations from the Canadian Task Force on Preventive Health Care, UK National Screening Committee, and US Preventive Services Task Force

Condition/guideline First author Year Country Number of patients randomized Eligibility and randomization Determined eligibility and randomized patients prior to screening? Diagnostic/treatment status Excluded already diagnosed and already treated patients? Management Similar management options for screened and unscreened trial arms?
Alcohol Misuse
 UKNSC Fleming 1997 USA [20] 774 Adult primary care practice patients who screened positive for problem drinking (men > 14 drinks per week, women > 11 drinks per week) were eligible and randomized No Patients with alcohol treatment program in the previous year or advice from physician to change alcohol use in previous 3 months were excluded Yes Intervention arm: general health booklet, 15-minute brief intervention and reinforcement session 1 month later; Control arm: general health booklet only No
Wutzke 2002 Australia [21] 554 Adult general practice patients who screened positive for problem drinking (men ≥ 300 g weekly, women ≥ 180 g weekly; two or more episodes of intoxication a month; or experiencing alcohol-related harm in the previous 6 months) were eligible and randomized No Patients with a history of hospital admission for an alcohol-related disorder or who had received advice from a health professional to abstain from alcohol were excluded Yes Intervention arm 1: 5 minutes of brief advice and a leaflet plus 15 minutes of counseling Intervention arm 2: 15 minutes of counseling with 2 additional counseling sessions; Control arm: 5 minutes of brief advice and a leaflet No
Crawford 2004 UK [22] 599 Adult emergency department patients who screened positive for alcohol misuse (men > 8 units of alcohol in any one session at least once a week, women > 6 units of alcohol in any one session at least once a week; patient believed their attendance in the emergency department could be related to alcohol) were eligible and randomized No Patients already in contact with alcohol services or who requested help with alcohol problems were excluded Yes Intervention arm: patients given an informational leaflet and offered a follow-up appointment with an alcohol health worker; Control arm: informational leaflet only No
Beich 2007 Denmark [23] 906 Adult primary care patients who screened positive on the AUDIT (score > 8 and < 21) with a maximum weekly consumption of 35 drinks were eligible and randomized No Patients receiving treatment for an alcohol use disorder at the time of enrollment were excluded Yes Intervention arm: patients offered feedback on present drinking, advice on reducing drinking, a self-help booklet, and an invitation for follow-up consultation; Control arm: no intervention received No
Depression
 USPSTF Callahan 1994 USA [24] 175 Adult primary care patients with CES-D ≥ 16 and HAMD ≥ 15 were eligible and randomized No 21% of enrolled patients already diagnosed and 12% already on antidepressants (overlap not specified) No Intervention arm: enhanced depression care; Control arm: usual care No
Williams 1999 USA [13] 969a Adult medical patients eligible and randomized to (1) screening with single mood question, (2) screening with the CES-D, or (3) usual care; depression outcomes only assessed for 97 patients with major depression at baseline and a random sample of 119 other patients Yesa Only 11 of 41 physician diagnoses of depression were new diagnoses (27%); patients classified as new diagnoses if no evidence of diagnosis in chart and patient reported that not diagnosed or treated in last 2 yearsb No Both groups received usual care Yes
Wells 2004 USA [25] 1356 Primary care clinics randomized; adult patients with probable depressive disorder were eligible No In the 6 months prior to trial, 48% of patients discussed emotional issues at medical visit; 29% had specialty mental health visit; 44% getting appropriate mental health care No Intervention arm: enhanced depression care; Control arm: usual care No
Whooley 2000 USA [32] 2346c Primary care patients ≥ 65 years were eligible and randomized to screening with GDS and seven educational sessions versus usual care; only 331 patients with GDS ≥ 6 at baseline were included in depression outcome analysis Yesc In the 12 months prior to trial, 20% of patients in outcome analysis prescribed antidepressant medication No Intervention arm: patients offered 6 weekly educational sessions on depression plus 1 booster session; Control arm: usual care No
Rost 2001 USA [26] 479 Primary care practices randomized; adult patients with five or more symptoms of current major depressive disorder were eligible No In the 6 months prior to trial, 44% of patients were prescribed antidepressant medication or had a specialty mental health care visit No Intervention arm: enhanced depression care; Control arm: usual care No
MacArthur 2002 UK [33] 2064 Midwife practices randomized; women receiving postnatal care in participating midwife practices were eligible Midwives used a symptom checklist and the EPDS to inform care plans and visit scheduling in intervention group, but not for screening Yes Existing depression diagnosis or treatment not in exclusion criteria; no information on depression diagnosis or treatment provided at time of enrollment No Intervention arm: multifaceted care enhancement, including training of midwives to implement new model of care and use of symptom checklist; Control arm: usual care No
Jarjoura 2004 USA [27] 61 Adult internal medicine patients positive for depression on PRIME-MD were eligible and randomized No Patients receiving intervention for mental health problems or seeking help for depression or other emotional problems were excluded Yes Intervention arm: nurse-supported depression management and referral program; Control arm: usual care No
Bergus 2005 USA [31] 51 Adult family practice patients with low mood or anhedonia in last 2 weeks based on PHQ-9 were eligible and randomized to have their PHQ-9 scores disclosed or not to their physician No 38% of enrolled patients on medication for depression or anxiety at time of enrollment and 60% had a history of depression treatment No Both groups received usual care Yes
Bijl 2003 [28] Bosmans 2006 Netherlands [29] 145 General practices randomized; patients with GDS ≥ 5 and positive for depression on PRIME-MD were eligible No Patients using antidepressants at time of trial enrollment were excluded Yes Intervention arm: enhanced depression care; Control arm: usual care No
Morrell 2009 UK [34] 4084 General practices randomized; only women with EPDS ≥ 12 at 6 weeks postpartum were included in outcome analyses Yesd Excluded women with severe mental health problems, but existing depression diagnosis or treatment not part of exclusion criteria; no information on depression diagnosis or treatment provided at time of enrollment No Intervention arm: home visits from health visitors with training in psychological approaches, along with screening and psychological interventions; Control arm: usual care No
Leung 2011 Hong Kong [14] 462 Women attending maternal and child health centers for routine child health services were eligible and randomized to screening with the EPDS versus usual care Yes Patients receiving psychiatric treatment were excluded Yes Both groups eligible to receive nurse counseling or a community psychiatry referral Yes
van der Weele 2012 Netherlands [30] 239 Primary care practices randomized; patients ≥ 75 years with GDS-15 scores ≥ 5 were eligible No Patients receiving treatment for depression at the time of enrollment were excluded Yes Intervention arm: stepped-care consisting of individual counseling, coping with depression course, and possible referral to general practitioner to discuss further treatment; Control arm: usual care No
Yawn 2012 USA [35] 2343d Primary care practices were randomized to a complex depression care intervention, including screening with EPDS and PHQ-9, versus usual care; women 5 to 12 weeks postpartum were eligible; only 408 patients with positive depression screen at baseline were included in depression outcome analysis Yese Existing depression diagnosis or treatment not in exclusion criteria; no information on depression diagnosis or treatment provided at time of enrollment No Intervention arm: enhanced depression care; Control arm: usual care No
Developmental Delay (CTFPHC) and Speech and Language Delay (USPSTF)
 CTFPHC Guevara 2013 USA [15] 2103 Pediatric patients < 30 months old, > 36 weeks’ estimated gestational age, with no major congenital anomalies or genetic syndromes, not in home foster care, and not currently receiving early intervention services were eligible and randomized to (1) screening with office assistance, (2) screening without office assistance, or (3) standard developmental surveillance without screening Yes Children receiving early intervention at the time of enrollment were excluded Yes Both groups eligible for referrals to early intervention services Yes
 CTFPHC  USPSTF de Koning 2004 [16] van Agt 2007 Netherlands [17] 10,355 Child healthcare physicians randomized to screening with the VTO Language Screening Instrument versus standard developmental surveillance without screening; children aged 15 to 18 months were eligible Yes Existing developmental delay diagnosis or treatment not in exclusion criteria; no information on developmental delay diagnosis or treatment provided at time of enrollment No Both groups eligible for standard speech and language assessments and early intervention Yes
Domestic Violence (UKNSC) and Intimate Partner Violence (USPSTF)
 UKNSC  USPSTF MacMillan 2009 Canada [18] 6743 Female primary care, emergency department, or obstetrics/gynecology patients who had a male partner at some point in the last 12 months were eligible and randomized to be screened with the WAST versus usual care Yes Already receiving treatment or help for domestic violence not in exclusion criteria; no information provided on how many women were receiving help for partner violence at time of enrollment No Both groups eligible to receive an information card with contact details for locally available resources for women exposed to violence Yes
 UKNSC Klevens 2012 USA [36] 2708 Female primary care patients eligible and randomized to (1) screening with the Partner Violence Screen instrument, (2) no screening (all receive a partner violence resource list), or (3) no screening (no list) Yes Already receiving treatment or help for domestic violence not in exclusion criteria; no information provided on how many women were receiving help for partner violence at time of enrollment No Intervention arm 1: women with positive screens receive informational video about hospital-based partner advocacy program, plus a partner violence resources list and a general resource list; Women with negative screen receive general resources list only; Intervention arm 2: partner violence resource list and general resource list to all women; Control arm: general resource list only to all women No
Suicide Risk
 USPSTF Crawford 2011 UK [19] 443 Adult primary care patients with signs of depression (“yes” to two-item screener) were eligible and randomized to be screened or not for suicide risk Yes Already receiving treatment or help for suicide risk not in exclusion criteria; no information provided on how many patients receiving treatment at time of enrollment No Intervention arm: patients with positive screens encouraged to use resources already available to them; Control arm: not described, but assumed to be same usual care as in intervention arm Yes
  1. aEligibility was determined and randomization occurred pre-screening; however, only 216 of 969 patients randomized (23%) were assessed for depression outcomes
  2. bBased on published article and clarification provided by corresponding author
  3. cEligibility was determined and randomization occurred pre-screening; however, only 331 of 2346 patients randomized (14%) were included in depression outcome analysis
  4. dPractices were randomized pre-screening; however, only 418 patients with EPDS scores of at least 12 were included in depression outcome analyses
  5. eEligibility was determined and randomization occurred pre-screening; however, of the 2343 patients randomized, only 408 (17%) with positive depression screens on the EPDS or PHQ were assessed for depression outcomes
  6. AUDIT Alcohol Use Disorder Identification Test, CES-D Center for Epidemiologic Studies Depression Scale, CTFPHC Canadian Task Force on Preventive Healthcare, HAM-D Hamilton Rating Scale for Depression, EPDS Edinburgh Postnatal Depression Scale, GDS Geriatric Depression Scale, PHQ-9 Patient Health Questionnaire-9, PRIME-MD Primary Care Evaluation of Mental Disorders, UKNSC United Kingdom National Screening Committee, USPSTF United States Preventive Service Task Force, VTO VroegTijdige Onderkenning Ontwikkelingsstoornissen, WAST Women Abuse Screening Tool