Who this is for
All three bodies recommend screening. They differ on who is covered.
Every adult 19 and older: USPSTF (2023) grades screening B for all adults, including pregnant and postpartum people and adults 65 and older: "The USPSTF recommends screening for depression in all adults regardless of risk factors." It applies to adults without a diagnosed mental health disorder or recognizable signs or symptoms of depression or suicide risk, and it targets major depressive disorder, not minor depression or dysthymia. Risk factors raise the odds without gating the screen; USPSTF names a family history of depression, a prior episode of depression or another mental health condition, a history of trauma or adverse life events, and illness such as cardiovascular disease, and for perinatal depression adds life stress, low social support and a history of abuse, among others.
Women in well-woman, prepregnancy, prenatal or postpartum care: ACOG's 2023 guideline (Clinical Practice Guideline No. 4) recommends that "everyone receiving well-woman, prepregnancy, prenatal, and postpartum care be screened for depression and anxiety", using standardized, validated questionnaires. It is a strong recommendation, on moderate-quality evidence for depression. The guideline is about pregnancy and the year after birth; its reach into well-woman care for women who are not pregnant rests on that one sentence, and it does not reach men. The Society for Maternal-Fetal Medicine endorses it.
Patients in VA or DoD care: VA/DoD (2022): "We suggest that all patients not currently receiving treatment for depression be screened for depression." It is a "Weak for" recommendation, carried forward from the 2016 guideline with a nominal change and no new evidence review, and the Work Group rated its confidence in the evidence low. The guideline is written for adults eligible for VA or DoD care, so it describes what those systems do.
Men: USPSTF covers men from 19, and VA/DoD covers men in VA or DoD care. ACOG's recommendation does not.
Already diagnosed, in treatment, or with symptoms: screening is not the next step. USPSTF's recommendation is for people without signs or symptoms, and VA/DoD's for patients not in treatment. Symptoms call for an evaluation, described under what happens next.
Where the recommendations diverge
- USPSTF 19 and older
- USPSTF Evidence insufficient 19 and older
- ACOG Not age-bounded
- ACOG Not age-bounded
- VA / DOD Not age-bounded
The USPSTF recommends screening for depression in the adult population, including pregnant and postpartum persons, as well as older adults.
Our note: Applies to adults 19 or older who do not have a diagnosed mental health disorder or recognizable signs or symptoms of depression or suicide risk, and focuses on major depressive disorder, not minor depression or dysthymia. Universal: "The USPSTF recommends screening for depression in all adults regardless of risk factors." Moderate certainty of moderate net benefit. Replaces the 2016 depression and 2014 suicide-risk statements, which USPSTF calls consistent with this one. No stop age is stated.
The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening for suicide risk in the adult population, including pregnant and postpartum persons, as well as older adults.
Our note: About screening adults with no signs, not about responding to suicidal thoughts. Clinician summary, spelling as published: "In the absence of evidence, health care professionals should use their judgement, based on individual patient circumstances, when determining whether to screen for suicide risk in adults not showing signs or symptoms." Harms USPSTF names include false positives leading to unnecessary referrals and treatment, labeling, anxiety and stigma. It notes the PHQ-9 already asks about suicidal ideation.
everyone receiving well-woman, prepregnancy, prenatal, and postpartum care be screened for depression and anxiety
Our note: An excerpt: the full sentence is ACOG's recommendation that these patients be screened with standardized, validated instruments. Grade as printed: "STRONG RECOMMENDATION, MODERATE- [DEPRESSION] AND LOW- [ANXIETY] QUALITY EVIDENCE", so moderate-quality evidence for depression. The guideline targets pregnant and postpartum patients; its reach into well-woman care rests on this sentence, and it does not reach men. Dated June 2023 with no day, so we record the first. Replaces Committee Opinion 757 (November 2018).
at the initial prenatal visit, later in pregnancy, and at postpartum visits
Our note: An excerpt: the sentence is ACOG's recommendation that screening for perinatal depression and anxiety happen at these three points. Its discussion places the later screen near or in the third trimester, and gives the reason: the onset of perinatal depression is spread nearly equally across prepregnancy, pregnancy and postpartum. Same printed grade as the row above. USPSTF's page still describes ACOG as recommending perinatal screening at least once, which is the superseded Committee Opinion 757.
We suggest that all patients not currently receiving treatment for depression be screened for depression.
Our note: Printed as "(Weak for | Not reviewed, Amended)": carried forward from the 2016 guideline with a nominal change and no new evidence review, and the Work Group rated its confidence in the evidence low. Version 4.0, February 2022, no day printed, so we record the first. The annual interval cites USPSTF's 2016 statement; the 2023 USPSTF statement found no evidence on the optimal frequency. This guideline states that it does not address patients at risk for suicide. The recommendation states no age; the guideline covers adults 18 and older.
Why they differ
The three agree that adults should be screened. They differ on who is covered, how firmly, how often, and what to do about suicide risk.
- Who. USPSTF covers every adult 19 and older; VA/DoD all patients not in treatment for depression, in a guideline for VA and DoD care; ACOG only people receiving well-woman, prepregnancy, prenatal or postpartum care.
- How firmly. USPSTF concludes "with moderate certainty that screening for MDD in adults, including pregnant and postpartum persons, as well as older adults, has a moderate net benefit." Its evidence: 17 screening trials showed higher rates of remission, or of scoring below a set symptom-severity threshold, after 6 to 12 months, and across all studies 93% of participants were women. ACOG's recommendation is strong, which its legend defines as "Benefits clearly outweigh harms and burdens. Most patients should receive the intervention." VA/DoD's is the weakest of the three, rated with low confidence in the evidence, and its discussion opens by deferring: "Consistent with the USPSTF recommendation, screening all patients for MDD and, if the screening results are positive, follow-up should be standard clinical practice."
- How often. USPSTF: "The USPSTF found no evidence on the optimal frequency of screening for depression." Its suggested pragmatic approach "might include screening adults who have not been screened previously and using clinical judgment while considering risk factors, comorbid conditions, and life events to determine if additional screening of patients at increased risk is warranted." VA/DoD's discussion text says "a reasonable approach as recommended by the USPSTF is to screen annually in patients not known to have depression", citing USPSTF's 2016 statement. The 2023 statement does not say annually, so annual screening is VA/DoD's reading, not USPSTF's current position. ACOG alone sets timepoints in a recommendation, and only around pregnancy: the first prenatal visit, again near or in the third trimester, and at postpartum visits.
- Suicide risk. USPSTF's I statement covers screening adults with no signs. ACOG, whose recommended questionnaires include a self-harm question, makes a strong recommendation, on low-quality evidence, that clinicians immediately assess risk whenever someone answers it yes, and writes that "Suicide prevention requires screening, assessment, monitoring, and intervention for all perinatal individuals." The VA/DoD depression guideline takes no position; it states that "This CPG does not address patients at risk for suicide" and points to a separate VA/DoD suicide-risk guideline. USPSTF's own summary of other bodies says the VA recommends universal suicide-risk screening in veterans and cites the 2022 depression guideline for it. That guideline contains no such recommendation, so this page does not rely on it.
One correction for readers of the USPSTF page: it describes ACOG as recommending perinatal screening at least once, citing Committee Opinion 757 (2018). ACOG's June 2023 guideline replaced that opinion and now asks for three perinatal timepoints plus screening in well-woman care.
4 documents set the numbers on this page. The oldest was published in 2022, the newest in 2023.
- USPSTF recommendation
- ACOG recommendation
- VA / DoD recommendation
- 988 Suicide & Crisis Lifeline home page (checked October 10, 2026)
We last re-read these sources on . How we verify.
What the test involves
You fill in the questionnaire yourself. ACOG says the PHQ-9 and EPDS come in multiple languages, are self-administered, take little time and can be scored by the care team, and that web, tablet and text message screening are acceptable to patients.
VA and DoD work in two steps, starting with the PHQ-2: "Note that the VA and DoD use a score of ≥3 to recommend further assessment." Then: "All patients who screen positive on the PHQ-2 should be assessed further for symptoms and risk level, including the full PHQ-9."
The accuracy trade-off, in USPSTF's figures. Against a semistructured interview, the PHQ-9 at its standard cutoff of 10 or greater identified 85% of participants with major depression and 85% of those without it. The PHQ-2 at 2 or greater was more sensitive, identifying 91% of those with major depression, but correctly identified only 67% of those without. Against a fully structured interview, the EPDS had a sensitivity of 81% to 90% and a specificity of 83% to 88% at cutoffs of 11 and 12. ACOG's table counts 10 or more on the EPDS or the PHQ-9 as a positive screen. Note the two PHQ-2 cutoffs: USPSTF reports its accuracy at 2 or more, while VA and DoD act on 3 or more.
A screen helps only if care follows. USPSTF: "Adequate systems and clinical staff are needed to ensure that patients are screened and, if they screen positive, are appropriately diagnosed and treated with evidence-based care or referred to a setting that can provide the necessary care." ACOG makes the same condition a strong recommendation of its own: systems that ensure timely assessment and diagnosis, effective treatment, and monitoring and follow-up based on severity.
If the result is abnormal
If you are thinking about suicide or self-harm, do not wait for a screening. In the United States, call or text 988, the Suicide & Crisis Lifeline, which says it is available 24/7/365 and that conversations are free and confidential. If you are in immediate danger, call 911.
A positive screen leads to an evaluation, not straight to a diagnosis. USPSTF: "All positive screening results should lead to additional assessments to confirm the diagnosis, determine symptom severity, and identify comorbid psychological problems." ACOG says the questionnaires "are screening instruments and not diagnostic instruments", and that diagnosis comes from evaluating the patient, including a discussion or interview. VA/DoD: "the use of the PHQ-9 as a diagnostic tool is discouraged."
The evaluation looks for other causes. ACOG names thyroid dysfunction, severe anemia and substance use disorder, assessed from symptoms and, where clinically indicated, with lab tests. VA/DoD: "Rule out depression secondary to other causes (e.g., hypothyroidism, vitamin B-12 deficiency, syphilis, pain, chronic disease)". It also asks clinicians to evaluate for suicidal and homicidal thoughts and past suicide attempts. ACOG recommends a bipolar screen before any medication for depression or anxiety is started, if one has not been done.
A yes on a self-harm question is handled at once. ACOG recommends that clinicians immediately assess the likelihood, acuity and severity of the risk and arrange management matched to it, and warns that a low overall score can still come with a yes on the self-harm question.
If depression is confirmed, USPSTF: "Effective treatment of depression in adults generally includes antidepressant medication or psychotherapy (eg, cognitive behavioral therapy or brief psychosocial counseling), alone or in combination." ACOG calls psychotherapy "first-line treatment for depression and anxiety regardless of symptom severity" and recommends referral to behavioral health resources. ACOG reads a PHQ-9 or EPDS score of 10 to 14 as often mild, 15 to 19 as moderate, and above 19 as severe, with an increased risk of bipolar disorder at the top. In pregnancy and while breastfeeding, USPSTF encourages clinicians to consider the unique balance of benefits and harms in the perinatal period. ACOG covers treatment in a separate guideline, No. 5 (June 2023), which this page does not draw on.
More on this screening
Frequently asked questions
I feel fine. Should I still be screened for depression?
Yes, on USPSTF's 2023 recommendation, which covers all adults 19 and older "regardless of risk factors" and applies to people without signs or symptoms. USPSTF cites an estimate that only half of patients with major depression are identified. If you are a woman in well-woman or pregnancy care, ACOG's 2023 guideline also recommends it, and VA/DoD suggests it for every patient in VA or DoD care who is not already being treated for depression.
How often should I be screened?
USPSTF found no evidence on the optimal frequency. Its suggested approach is to screen adults who have not been screened before, then use clinical judgment, weighing risk factors, other conditions and life events, on whether more screening is warranted. VA/DoD's discussion text suggests screening annually and credits that to USPSTF's 2016 statement, which the 2023 statement does not repeat. In pregnancy, ACOG sets three points: the first prenatal visit, near or in the third trimester, and postpartum visits.
Why doesn't USPSTF recommend screening for suicide risk?
Because it found the evidence insufficient to weigh the benefits and harms of screening adults who show no signs, so in 2023 it issued an I statement. It leaves the decision to the clinician's judgment for the individual patient, notes that the PHQ-9 already includes a question about suicidal ideation, and names the possible harms of screening: false positives, unnecessary referrals and treatment, labeling, anxiety and stigma. ACOG makes a strong recommendation that any yes to a self-harm question be assessed immediately.
My PHQ-9 score was 12. Do I have depression?
A score cannot tell you that. ACOG's table counts 10 or more on the PHQ-9 as a positive screen, and ACOG reads 10 to 14 as often mild symptoms, but it calls these screening instruments, not diagnostic ones, and VA/DoD discourages using the PHQ-9 as a diagnostic tool. The next step USPSTF names is additional assessment to confirm the diagnosis, determine severity and identify other psychological problems, alongside a check for other causes such as thyroid dysfunction, severe anemia or vitamin B-12 deficiency.
I am pregnant. When will I be screened?
ACOG (2023) recommends screening at the first prenatal visit, again near or in the third trimester, and at postpartum visits, because perinatal depression begins about equally often before, during and after pregnancy. USPSTF includes pregnant and postpartum people in its grade B recommendation and sets no timing. VA/DoD's discussion text says pregnant and postpartum women should be screened at their first antenatal and postnatal visits, and that screening is typically repeated four to six weeks and three to four months after birth. If USPSTF's page tells you ACOG asks for screening at least once, that describes ACOG's 2018 opinion, which the 2023 guideline replaced.
I am having thoughts of harming myself. Should I wait for a screening?
No. If you are thinking about suicide or self-harm, call or text 988, the Suicide & Crisis Lifeline, now; if you are in immediate danger, call 911. Every screening row on this page is about people with no signs: USPSTF's recommendation covers adults without recognizable signs or symptoms of depression or suicide risk. Thoughts of self-harm are such a sign, so tell a clinician now rather than waiting for a scheduled screen. ACOG's guideline treats any yes on a self-harm question as needing immediate assessment, whatever the total score, and VA/DoD's initial work-up includes an evaluation for suicidal thoughts.