Screening and management of adolescent depression in a large pediatric care network

There is low access to adolescent depression care due to lack of identification, a shortage of mental health professionals, and personal and logistical barriers to seeking treatment. Primary care has therefore been promoted as a setting to identify and manage this prevalent and impairing condition. Data for this study came from electronic health record (EHR) extraction in a large pediatric care network with an organizational recommendation to screen for depression at age 16 well visits using a tablet-based, EHR-integrated version of the Patient Health Questionnaire - Modified for Teens (PHQ-9-M). Analyses examined rates of screening and elevated symptoms during a two-year period. For at-risk patients (those with threshold and subthreshold scores on the PHQ-9-M), analyses explored primary care providers' (PCPs') immediate responses and follow-up care over approximately one year. In a selected subsample of at-risk patients, manual EHR chart review further assessed follow-up care and adherence to guidelines for the management of adolescent depression in primary care. Results indicated that, across 27 practices conducting screening, 76.25% (n=6,981) of patients attending their age 16 well visit were screened. About one-quarter of screened patients had an elevated score (6.73% threshold; 19.23% subthreshold). On the date of their well visit, 37.28% of at-risk patients received active follow-up by their PCP (e.g., behavioral health referral, emergency procedures for suicidality) according to EHR-extracted progress note documentation. Over one year, 75.54% of patients with threshold scores and 39.97% of patients with subthreshold scores received follow-up care (e.g., depressive disorder diagnosis, antidepressant medication) according to EHR data extraction. More detailed examination via manual EHR chart review suggested higher follow-up rates. This study demonstrated that, using current technologies, routine adolescent depression screening is feasible across diverse primary care settings. For many adolescents, screening identified previously undetected concerns and resulted in treatment initiation. However, PCPs require additional support to manage increased adolescent depression identification through universal screening programs. Investment in primary care-based care coordination and mental health services is needed to ensure high-quality treatment and ultimately decrease the burden of adolescent depression.M.S.Includes bibliographical reference