This week we will be discussing an article that was published in the Journal of Pediatric Nursing last month. In the article, Outcomes of Depression Screening for Adolescents Accessing Pediatric Primary Care-Based Services, authors Chowdhury and Champion assess outcomes of depression screening among adolescents accessing pediatric primary care services.

What did they do?

The authors of this study conducted a retrospective review of the electronic medical records of adolescents between the ages of 12 and 18 years who received regular health care at a pediatric primary care facility. The medical records were then examined for data including socio-demographic information, PHQ-9 score (i.e., the primary measure of depression in this study), provider type (nurse practitioner versus physician), and any information concerning referral/initiation of medication or plan of care and follow up. 

Why did they do it?

Half of all mental health-related difficulties emerge during adolescence, and existing research suggests that the prevalence of depression among adolescents is approximately 10-15%. As such, brief depression measures (e.g., the PHQ-9) are often embedded into the workflow of primary care visits. With evolving research indicating that adolescent depression leads to functional impairment and increased morbidity and mortality, the authors of this study sought to assess the varying outcomes related to the implementation of the PHQ-9 in a pediatric setting, in an attempt to contribute to the refinement of clinical protocols for depression screening, as well as intervention and follow up procedures.

How did they do it?

The authors retrospectively reviewed medical records of 1,213 adolescents who accessed a pediatric clinic and were administered a PHQ-9. They then identified a subgroup of adolescents (n = 96) with PHQ-9 scores indicating the presence of at least mild depression (scores > 5). PHQ-9 scores were then compared across a variety of patient demographic and practitioner variables.

What did they find?

No differences in the frequency of endorsement of mild depression across females (n = 34, 70.8%) or males (n = 36, 75%) were identified. Fewer females (n = 9, 18.8%) than males (n = 11, 22.9%) reported moderate depression and more females (n = 5, 10.4%) than males (n = 1, 2.1%) reported severe depression. 

Of the adolescents identified as experiencing mild to high depressive symptoms, less than half were actually given a referral during their primary care visit, and only 17 (17.5%) were currently involved in therapy. Referrals based on level of depression were also compared. The authors found that 38.6% (n = 27) of adolescents with mild depression, 55% (n = 11) of adolescents with moderate, and 66.7% (n = 4) of adolescents with moderately severe depression were provided a referral.

What does it all mean (our take)?

We have written previously that the primary care setting provides a great opportunity for providers to assess the behavioral health of their patients, and provide referrals as necessary. The problem: time. Primary care doctors quite simply do not have the time to administer more comprehensive mental health measures nor do they have the time to thoroughly review results and refer patients accordingly. In addition, many primary care doctors do not receive comprehensive training in the domain of mental health assessment/intervention.

The ability to maximize the utility of the primary care visit with regard to evaluating patient mental health will be contingent on the development of creative technology solutions. It is our goal to continue working to meet the needs of primary care doctors, as well as others, who would benefit from an improved system to help evaluate and refer their patients with mental health difficulties.

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