Mental HealthAnxiety and Depression Screening for Youth in a Primary Care Population
Section snippets
Setting
Group Health Cooperative is a nonprofit health maintenance organization in Washington, with 25 Group Health Cooperative–owned primary care clinics and 75 contracted clinics. The study protocol was reviewed and approved by the institutional review board of Group Health Cooperative.
Subjects and Recruitment
Potential subjects, aged between 11 and 17 years and who were enrolled in Group Health Cooperative for 6 months or more, were identified from administrative data. All youth with asthma identified via automated data of
Results
Of the 1458 youth with asthma in the initial sample, 1288 proved eligible (Figure) and 833 eligible parents gave consent to contact their child/adolescent with asthma. Of these, 781 child/adolescent interviews were completed, for a final recruitment rate of 60.6%. Of the 1360 control youth without asthma, 1183 proved eligible and 648 eligible parents gave consent to contact their child/adolescent without asthma. Five hundred ninety-eight control youth interviews were completed, for a
Discussion
Our results suggest that both the MFQ-SF and the ASI have relatively high sensitivity and specificity and performed well on the ROC analysis for screening youth for 1 or more DSM-IV anxiety or depressive disorders. These screening tools also have the advantage of being brief and easy to administer. The majority of primary care physicians report that it is their responsibility to identify anxiety and depression in youth,28 but few are using standardized tools to screen for the disorders.29 Our
Conclusion
Multiple studies have found low rates of recognition of anxiety and depressive disorders by pediatricians.9, 10 Screening for anxiety and depressive disorders could improve detection, but improved patient-level outcomes will probably require changes in the way primary care is organized. One large study showed that when screening for depression was coupled with a primary care–based quality improvement program aimed at enhanced exposure of youth to evidence-based treatment, there was evidence of
Acknowledgment
This study was supported by grants from the National Institute of Mental Health to Dr Katon (MH-067587 and MH-069741).
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Clinical Practice Guideline for the Assessment and Treatment of Children and Adolescents With Major and Persistent Depressive Disorders
2023, Journal of the American Academy of Child and Adolescent PsychiatryCitation Excerpt :For this reason, primary care settings using remote screening might consider the adolescent-validated,90 freely available PHQ-2 instrument, which does not include suicidality items (https://www.primarypediatrics.com/wp-content/uploads/2020/04/PHQ-2-Depression-Scale.pdf),91 for the initial depression screen, to be followed by in-person administration of the PHQ-9 at the well visit if the PHQ-2 score is positive. For younger children, a similar remote screening consideration could be the child and adolescent−validated,92-95freely available Short Mood and Feelings Questionnaire (SMFQ), which does not include suicidality items, to be followed by in-person administration of the Long Mood and Feelings Questionnaire (LMFQ) at the well visit if the SMFQ score is positive (https://devepi.duhs.duke.edu/measures/the-mood-and-feelings-questionnaire-mfq/).96 In the context of a psychiatric evaluation, symptoms of depression typically are identified through input from referral sources; spontaneous youth or parent report (the presenting problem or chief complaint); or during the clinician’s review of psychiatric symptoms or the conduct of the mental status examination.
Depression and suicide screening
2019, Adolescent Health Screening: An Update in the Age of Big DataIdentifying key parent-reported symptoms for detecting depression in high risk adolescents
2016, Psychiatry ResearchFactors that impact mental health help-seeking in Australian adolescents: a life-course and socioecological perspective
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