Elsevier

Ambulatory Pediatrics

Volume 8, Issue 3, May–June 2008, Pages 182-188
Ambulatory Pediatrics

Mental Health
Anxiety and Depression Screening for Youth in a Primary Care Population

https://doi.org/10.1016/j.ambp.2008.01.003Get rights and content

Objective

Prior studies have shown a low rate of accurate identification by primary care physicians of mental health disorders in youth. This study tested the psychometric properties of 2 brief mental health screening questionnaires, the Mood and Feelings Questionnaire, short form, (MFQ-SF) and Childhood Anxiety Sensitivity Index (ASI), in a large sample of youth.

Methods

In a sample of 1375 youth aged 11 to 17 (779 with asthma, 596 randomly selected controls) enrolled in a health maintenance organization, the psychometric properties (optimum cutoffs on receiver operator characteristic (ROC) curves, sensitivity, specificity, positive and negative predictive values) of 2 brief anxiety and depression screens were compared with a gold standard–structured psychiatric interview.

Results

Both the MFQ-SF and ASI performed well on ROC analysis for screening youth for 1 or more Diagnostic and Statistical Manual of Mental Disorders-IV (DSM-IV) anxiety or depressive disorders. The MFQ-SF performed better on ROC analysis than the ASI for youth with major depression (area under the curve of 0.84 vs 0.77). For screening youth with anxiety disorders, ROC curves showed that both the MFQ-SF and ASI only performed in the fair range (area under the curve of 0.76).

Conclusion

The MFQ-SF and ASI are 2 relatively brief questionnaires that performed well for screening youth for 1 or more DSM-IV anxiety or depressive disorders. The MFQ-SF performed better than the ASI for screening youth with major depression. Use of these instruments could increase the accuracy of identification of mental health disorders in youth by primary care physicians.

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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