Screening for and Diagnosis of Depression Among Adolescents in a Large Health Maintenance Organization

Abstract

OBJECTIVE The aim of this analysis was to determine changing patterns of depression screening and diagnosis over three years in primary and specialty mental health care in a large health maintenance organization (HMO) as part of a quality measure development project. METHODS Two series of aggregate data spanning three years (2010–12) were gathered from the electronic health record of the HMO summarizing unique adolescents age 12–21 (N=44,342) who had visits in primary and mental health care. Chi-square tests assessed the significance of changing frequency and departmental location of PHQ-9 administration, incident depression symptoms, and depression diagnoses. RESULTS There was a significant increase in PHQ-9 use from 2010 to 2012, predominantly in primary care, consistent with internally generated organizational recommendations to increase screening with the PHQ-9. The increase in PHQ-9 use led to an increase in depression diagnoses in primary care and shift in the location of some diagnoses from specialty mental health care to primary care. The increase in PHQ-9 use was also linked to an increase in the proportion of positive PHQ-9 results not leading to formal depression diagnoses. CONCLUSIONS The rate of depression screening in primary care increased over the study period. This increase corresponded to an increase in the number of depression diagnoses made in primary care and a shift in the location of depression diagnoses made from the mental health department to primary care. The frequency of positive PHQ-9 administrations not associated with depression diagnoses also increased.

Guidelines for Adolescent Depression in Primary Care (GLAD-PC): Part I. Practice Preparation, Identification, Assessment, and Initial Management

“…Forty percent of the sample did not meet the criteria for MDD but were deemed to be impaired enough with depressive symptoms to enter the study. When Lewandowski et al 74 studied the large-scale use of the PHQ-9 modified in the health maintenance organization (HMO), they looked at whether any depressive disorder was identified, even adjustment disorder, rather than just MDD. The Youth Partners in Care (YPIC) intervention 11,58 also included teenagers without MDD who had clinically significant and current depressive symptoms.…”

Promoting Youth Mental Health via Text‐Messages: A New Zealand Feasibility Study

“…All of the measures have been previously tested with adolescent samples and found to have acceptable psychometric properties (e.g. Allgaier, Pietsch, Fruhe, Sigl‐Glockner, & Schulte‐Korne, ; Andreas & Brunborg, ; Anstiss & Davies, ; Calear et al., ; Esnaola, Benito, Antonio‐Agirre, Freeman, & Sarasa, ; Froh et al., ; Inauen et al., ; Lewandowski et al., ; Neto, ), and several have been extensively validated across multiple cultures (e.g. Satisfaction with Life Scale, WHO‐5 Well‐Being Index, and the Rosenberg Self‐Esteem Scale).…”

Pediatric Attention-Deficit/Hyperactivity Disorder in Louisiana: Trends, Challenges, and Opportunities for Enhanced Quality of Care

“…52 For children older than 8 years, the Pediatric Symptom Checklist-17 can be used to explore a broad range of symptoms, including mood and anxiety. 53,54 Other measures such as the Patient Health Questionnaire-9A 26,55,56 or the Screen for Child Anxiety Related Emotional Disorders 57,58 can be used in cases of suspected depression or anxiety, respectively. To explore environmental stressors, primary care clinicians can consider using tools such as the Safe Environment for Every Kid (SEEK), 59 Well-Child Care Visit, Evaluation, Community Resources, Advocacy, Referral, Education (WE CARE), 60 or Center for Youth Wellness Adverse Childhood Experiences Questionnaire.…”