Predictors of Persistence After a Positive Depression Screen Among Adolescents

Abstract

WHAT'S KNOWN ON THIS SUBJECT: Adolescents have high placebo response rates in depression treatment trials. Screening for depression will likely detect youth with a broad range of symptom severity, including some who would benefit from watchful waiting but might not require active treatment. WHAT THIS STUDY ADDS:The strongest predictors of symptom persistence are depressive symptom severity at presentation and continued symptoms on repeat screening 6 weeks later. These results provide important information for the development of postscreening management protocols in the primary care setting. abstract OBJECTIVE: To examine predictors of depression persistence after a positive screening test to inform management protocols for screened youth. METHODS:We conducted a cohort study of 444 youth (aged 13-17 years) from a large health care delivery system. Youth with depressive symptoms, based on a 2-item depression screen, were oversampled for the baseline interview. Baseline assessments included the Patient Health Questionnaire 9-item (PHQ-9) depression screen as well as clinical factors that were hypothesized to influence depression persistence (family history of depression, functional impairment, perceived social support, anxiety symptoms, externalizing symptoms, and medical comorbidity). Logistic regression analysis was used to examine factors associated with the persistence of depression at 6 months postbaseline. RESULTS:Of 113 youth with a positive baseline screen (PHQ-9 $11), 47% and 35% continued to be positive at 6-week and 6-month followup, respectively. After controlling for treatment status, only 2 factors were significantly associated with depression persistence at 6 months: baseline depressive symptom score and continuing to have a positive screen at 6 weeks. For each 1-point increase on the PHQ-9 score at baseline, youth had a 16% increased odds of continuing to be depressed at 6 months (odds ratio: 1.16, 95% confidence interval: 1.01-1.34). Youth who continued to screen positive 6 weeks later had almost 3 times the odds of being depressed at 6 months (odds ratio: 2.89, 95% confidence interval: 1.09-7.61). CONCLUSIONS:Depressive symptom severity at presentation and continued symptoms at 6 weeks postscreening are the strongest predictors of depression persistence. Patients with high depressive symptom scores and continued symptoms at 6 weeks should receive active treatment. Pediatrics 2012;130:e1541-e1548 AUTHORS: