Do you feel as though we’re in the middle of an epidemic of mental health disease? If the answer is yes, you’re not alone. I think that most clinicians are feeling this. And it certainly seems like the pandemic is not helping the situation.
Thus, the question of how best to screen adolescents for depression and suicide risk seems more urgent these days. This week, we are early releasing in Pediatrics an important article by Dr. Alex Kemper and colleagues at the Ohio State University, entitled, “Depression and Suicide-Risk Screening in Pediatric Primary Care.” (10.1542/peds.2021-049999)
The authors assessed 2 commonly used screening tools: the Patient Health Questionnaire-9 Modified for Adolescents (PHQ-9A) and the Ask Suicide-Screening Questions (ASQ). In particular, they assessed different screening strategies using these tools among 12–20-year-olds who were seen in 12 primary care practices in Columbus, Ohio. All patients were screened with both the PHQ-9A and the ASQ at the same visit. Two different screening thresholds were used with the PHQ-9A: a positive screen for any depression and a positive screen for major depressive disorder. For the ASQ, a positive response to any of the 4 questions was considered a positive screen.
Out of 803 adolescents, 453 (56.4%) had a positive PHQ-9A for any depression, and nearly half of these (198) scored positive for a major depressive disorder. 21.1% had a positive ASQ screen. Of note, of those who said on the PHQ-9A that they had not had any suicidal thoughts in the past month, 93 (13.2%) had a positive ASQ screen, which specifically screens for suicidal risk.
The adolescents in this study were recruited between June 2019 and October 2020, so the authors did what we all wanted them to do—they evaluated whether there were any changes in the rate of positive depression screens during the first 6 months of the pandemic. Check out the article to see if their results are consistent with your anecdotal experience. There are also subgroup analyses that will be of interest to you.
Bottom line: standardized screening for depression is important for pediatric and adolescent patients, but using the PHQ-9A may not be sufficient to identify those at risk for suicide.
If you are not routinely screening for depression among your patients, you may be surprised by these results. If you are routinely screening for depression, I wonder if you are seeing such high proportions of positive screens in your patients – and how you are addressing these mental health needs, particularly since there is a shortage of mental health professionals who are comfortable working with pediatric and adolescent patients.