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Online ISSN: 1099-176X Print
ISSN: 1091-4358 Copyright © 2026 ICMPE. |
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Unveiling the Value of Early Depression Screening in U.S. Adults: A Systematic Review of Clinical Benefits and Economic Returns |
Ya’akov M. Bayer,1* Tzion Dadon,1 Ephraim Schreiber2 |
1Department of Health Policy and Management, Ben Gurion University
of the Negev & Be’erot, Beer Sheva Mental Health Center, 2Shalvata Mental Health Center, Hod Hasharon & Gray Faculty of Medical & Health Sciences, Tel Aviv, Israel |
*Correspondence to: Ya’akov Bayer, Ph.D., Department of Health Policy and Management, Ben Gurion University of the Negev & Be’erot, Beer Sheva Mental Health Center, Beer Sheva & Achva Academic College, Beer Tuvia, Israel
Source of Funding: None
declared.
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| This systematic review examines the clinical and economic value of early depression screening among U.S. adults. Although depression constitutes a significant health and economic burden, screening implementation remains inconsistent across healthcare systems. Evidence shows that combining proactive screening with structured follow-up care significantly enhances clinical outcomes, reduces hospitalizations, and minimizes productivity loss. Economically, integrated care models are proven to be highly cost-effective, yielding a positive and substantial return on investment for various healthcare payers. The financial savings and economic viability are primarily driven by avoiding costly psychiatric inpatient days, decreasing emergency medical utilization, and improving workforce productivity. Meanwhile, although digital and AI-based tools offer the potential for additional cost savings, their practical feasibility is currently limited by high user dropout rates and fundamental data privacy concerns. Future policies must carefully address these specific technological barriers while promoting equitable access to maximize overall clinical and societal benefits. | |
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. |
Received 18 July 2025; accepted 26 February 2026
Copyright © 2026 ICMPE