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Further research is needed in understanding how patients with low levels of understanding of depression as a legitimate disorder and recognition of depressive symptoms are likely to respond to screening tools such as the PHQ-9.
We have previously reported that those who fail to respond to screening are more likely to be male, younger and more socio-economically deprived, and that those who fail to progress to colonoscopy following a positive test are more likely to be deprived (Mansouri et al, 2013).
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Nonwhite respondents were also less likely ever to have responded to screening invitations than white respondents (41.5% versus 70.5%, p < 0.001).
In both the second and third rounds, the positive rate was highest in those who had not previously accepted screening and lowest in people who had responded to screening in the previous round (in the third round, the rates were 2.9%and1.5%5%, respectively (table 3)).
We recognise the limitations of this approach; it does not sufficiently differentiate between ethnic minority populations, and depends on individuals within ethnic groups responding to screening in a consistent way.
Additionally, it may be that women are more willing to respond positively to screening items compared to men.
This might have a positive impact on screening uptake among those who have not responded to earlier screening invitations [ 21].
However opportunistic approaches provide important supplementary supports to more systematic population screening efforts, and therefore understanding how individuals respond to opportunistic screening is important.
About 35% of the women in the Netherlands do not respond to the screening invitation (referred to as non-responders).
This flexible approach allows people to respond to the screening invitation in a way that suits them best.
Subjects who do not respond to the screening invitation are sent a reminder 28 days after mailing the test kit.
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