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Suicide Risk Plus Depression Screening May Improve Treatment Rates Among Adolescents

AUTHOR:
Brittany Perry, DO
Nemours/Alfred I. duPont Hospital for Children


CITATION:
Perry B. Suicide risk plus depression screening may improve treatment rates among adolescents. Consultant360. Published online July 13, 2021.

Kemper AR, Hostutler CA, Beck K, Fontanella CA, Bridge JA. Depression and suicide-risk screening results in pediatric primary care. Pediatrics. 2021;148(1):e2021049999. https://doi.org/10.1542/peds.2021-049999 

Depression is underdiagnosed and undertreated in pediatrics. About 13% of adolescents have major depressive disorder (MDD), but fewer than 20% of those who receive a diagnosis also receive treatment.1 Suicide is the third-leading cause of death in adolescents,2 and both suicidal ideations and suicide attempts have increased during the COVID-19 pandemic.3 The US Preventive Services Task Force recommends screening for depression in adolescents aged 12 to 18 years.4 The American Academy of Pediatrics also recommends annual screening for depression using a screening tool, as well as targeted screening during other health visits if indicated.5 Primary care providers have a unique opportunity to identify depression and initiate a treatment plan for their adolescent patients. 

In a paper published in Pediatrics, Kemper and colleagues6 studied positive screening rates of depression using the Patient Health Questionnaire-9 Modified for Adolescents (PHQ-9A) and additional yield of positive results when screening for suicide risk using the Ask Suicide Screening Questions (ASQ) in a primary care network. Screening results prior to the COVID-19 pandemic were compared with screening results during the COVID-19 pandemic. Additionally, the researchers evaluated diagnoses of depression or self-harm and antidepressant prescriptions after screening. Patients were enrolled in the study if they were older than age 12 years, completed both screening tools, did not have a prior history of depression, and were not prescribed an antidepressant in the prior 6 months. Overall, 800 participants were included in the analysis. 

On the PHQ-9A, 56.4% of participants had screened positive for any type of depression, 24.7% had screened positive for MDD, and 12.1% had reported suicidal thoughts within the last month. On the ASQ, 21.1% of participants had screened positive for suicide risk and 3.6% had felt suicidal at the time of screening. Of note, 13.2% of participants who had a positive ASQ did not report suicidal thoughts in the past month on PHQ-9A screening, and 18 participants who screened positive on the ASQ had a negative PHQ-9A screen for depression. The researchers did not find a statistical difference over time in the rate of positive screens for MDD or suicide risk before and during the COVID-19 pandemic. However, they note that these findings may not be generalizable to adolescents who were not seen for care during the pandemic. Participants were more likely to receive a diagnosis of depression or self-harm and be prescribed an antidepressant medication if they had screened positive for MDD compared with any other form of depression.

This study highlights the high prevalence of adolescent depression and the opportunity to provide interventions for patients who may be experiencing less severe depression symptoms or suicidal ideations only. The use of both depression and suicide-risk screening tools together may identify more adolescents at risk, but more research is needed to evaluate their use. 

References

  1. Prevalence of major depressive episode among adolescents. Major Depression. National Institute of Mental Health. Updated February 2019. Accessed July 12, 2021. https://www.nimh.nih.gov/health/statistics/major-depression#part_155031
  2. Miniño A. Mortality among teenagers aged 12-19 years: United States, 1999-2006. NCHS Data Brief. 2010;(37):1-8. https://www.cdc.gov/nchs/products/databriefs/db37.htm 
  3. Hill RM, Rufino K, Kurian S, Saxena J, Saxena K, Williams L. Suicide ideation and attempts in a pediatric emergency department before and during COVID-19. Pediatrics. 2021;147(3):e2020029280. https://doi.org/10.1542/peds.2020-029280 
  4. Siu AL; US Preventive Services Task Force. Screening for depression in children and adolescents: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med. 2016;164(5):360-366. https://doi.org/10.7326/m15-2957 
  5. Zuckerbrot RA, Cheung A, Jensen PS, Stein REK, Laraque D; GLAD-PC STEERING GROUP. Guidelines for Adolescent Depression in Primary Care (GLAD-PC): Part I. Practice preparation, identification, assessment, and initial management. Pediatrics. 2018;141(3):e20174081. https://doi.org/10.1542/peds.2017-4081 
  6. Kemper AR, Hostutler CA, Beck K, Fontanella CA, Bridge JA. Depression and suicide-risk screening results in pediatric primary care. Pediatrics. 2021;148(1):e2021049999. https://doi.org/10.1542/peds.2021-049999