Depression


Adolescent Depression Screening

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Depression is prevalent in today’s population and has significant impact one’s development and well-being.1 An estimated 3.1 million adolescents aged 12 to 17 in the United States had at least one major depressive episode. This number represented 12.8% of the U.S. population aged 12 to 17. 2 Adolescent depression (i.e. symptoms) affect nearly 10% of teenagers, 3-6 and is misdiagnosed in almost 75% of adolescents, causing significant morbidity.7-8 Associations with adolescent depression demonstrate risks of educational underachievement, impaired peer and family relationships, and an exacerbation of the severity of health conditions such as anxiety and depression as well as illicit drug dependence.9 For this reason it is critical that providers screen and diagnosis adolescent depression in their practices.

Measuring Your Progress

To screen, recognize and diagnose to identify adolescent patients with depression: 

  • Consider the following inclusion criteria for data collection:

    Inclusion Criteria –

    • Patients 12 years or greater seen for well-child visits

    • First 17 eligible charts each month

  • Consider the Project RedDE! Conceptual Model for Adolescent Depression Screening:

    • SCREEN: Was the patient screened for depression?

    • RECOGNIZE: Did the provider document depression concerns or the exclusion of depression concerns?

    • DIAGNOSE: Does the patient have documentation of major depression, dysthymia, or sub-syndromal depression as part of the problem list, assessment or billing record?

For more details on the above measures, please see the measures grid.

Tools to support Reducing Diagnostic Errors in Screening for Adolescent  Depression

Top Tools:

At the end of the project, we surveyed participants on the tools they found to be most useful. The following is a list ranked in order of what was most helpful throughout the course of the collaborative.

  1. PHQ9-Modified for Teens – This is an instrument for screening, diagnosing, monitoring and measuring the severity of depression. English | Spanish

  2. Algorithm for Diagnosis and Management of Adolescent Depression from the GLAD-PC Guideline* – This is a flowchart for adolescent depression screening, diagnosis and treatment from the GLAD-PC guideline. 

  3. AAP Motivational Interviewing to identify and address teen depression – This video focuses on using motivational interviewing techniques to identify and address depression. 

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​       4. Depression Education materials for Patients and Families* – These are information sheets and self-management tools to give to your patients and families if they or their child has identified as having depression.

                    1. Education Materials for Patients 

                    2. Education Materials for Families

       5. Community Mental Health Finder Website – This online tool from the American Academy of Child and Adolescent Psychiatry will assist you in finding and choosing a child and adolescent psychiatrist. 

Adolescent Depression Video Testimonials

Watch the below videos of some of the practices that participated in project RedDE! discussing challenges with screening for and diagnosing adolescent depression, and how they addressed and overcame those challenges.

    References

    1. National Institute of Mental Health.  https://www.nimh.nih.gov/health/statistics/major-depression.shtml

    2. 2016 National Survey on Drug Use and Health.  Substance Abuse and Mental Health Services Administration.  Center for Behavioral Health Statistics and Quality

    3. Rockville, Maryland.  September 2017

    4. Garrison CZ, Addy CL, Jackson KL, McKeown RE, Waller JL. Major depressive disorder and dysthymia in young adolescents. Am J Epidemiol 1992;135:792-802.

    5. Whitaker A, Johnson J, Shaffer D, et al. Uncommon troubles in young people: prevalence estimates of selected psychiatric disorders in a nonreferred adolescent population. Archives of general psychiatry 1990;47:487-96.

    6. Shaffer D, Fisher P, Dulcan MK, et al. The NIMH Diagnostic Interview Schedule for Children Version 2.3 (DISC-2.3): description, acceptability, prevalence rates, and performance in the MECA Study. Methods for the Epidemiology of Child and Adolescent Mental Disorders Study. Journal of the American Academy of Child and Adolescent Psychiatry 1996;35:865-77.

    7. Lewinsohn PM, Hops H, Roberts RE, Seeley JR, Andrews JA. Adolescent psychopathology: I. Prevalence and incidence of depression and other DSM-III-R disorders in high school students. Journal of abnormal psychology 1993;102:133-44.

    8. Glazebrook C, Hollis C, Heussler H, Goodman R, Coates L. Detecting emotional and behavioural problems in paediatric clinics. Child: care, health and development 2003;29:141-9.

    9. Eaton DK, Kann L, Kinchen S, et al. Youth risk behavior surveillance - United States, 2011. Morbidity and mortality weekly report Surveillance summaries 2012;61:1-162.

    10. Woodward LJ, et al.  Life Course Outcomes of Young People with Anxiety Disorders in Adolescence.  Journal of the American Academy of Child & Adolescent Psychiatry. 2001, 40(9): 1086 – 1093.

​Acknowledgements

*These tools are from the 2018 Guidelines for Adolescent Depression in Primary Care (Glad-PC) Toolkit. We acknowledge the input of the Glad-PC Toolkit Authors and Committee, Committee.

Authors: Amy Cheung, M.D, Rachel A. Zuckerbrot, M.D., and Peter S. Jensen, M.D. (2018)

Committee: Rachel A. Zuckerbrot, MD, Amy Cheung, MD, Peter S. Jensen, MD, Kareem Ghalib, MD, Kelly J. Kelleher, MD, Brenda Reiss-Brennan, APRN, Meghan Tomb, BA, Lauren Zitner, BA.

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