EBA on Screening for Depression in Children and Adolescents

Depression is a leading cause of disability in the United States. As a health care professional, you will treat clients’ with primary and secondary diagnoses of depression. Depression is defined as a condition of general emotional dejection and withdrawal; sadness greater and more prolonged than that warranted by any objective reason. Clinical depression is depression that is so severe that it is considered abnormal, either because of no obvious environmental changes, or because the reaction to unfortunate life circumstances is more intense or prolonged than would generally be expected. Depression is not an adult only disease. Health care providers are treating more and more cases of pediatric depression than ever before. In 2009 roughly 8% of American children ages 8-15 reported having major depression in the past year. Major depressive disorder (MDD) causes a child to fall behind in school and work due to functional impairments in their performance and lack of familial interactions. Depression has been shown to negatively impact the development of children. A strong correlation has been detected between childhood MDD and adulthood depression, mental disorders, suicidal ideation, suicidal attempts, and suicidal completion. According to the American Foundation for Suicide Prevention from 2000-2014, on average 42,773 Americans die by suicide each year. The 42,773 annual number of American suicides is heartbreaking; especially since 11.6% of 42,773 suicide completions were made by children and young adults ages 15-24. Health care professionals recognize the statistics and seek interventions to decrease suicide rates not only in the Unites States, but worldwide.  

(Example of suicide rates per state)

      US Preventative Task Force (USPTF) has conducted numerous studies to provide healthcare professionals with evidence-based practices to implement throughout their clinical practice to address the concerning issues of childhood suicide. The population studies concern individuals under the age of 18. The USPTF studies focus on the screening for MDD in children and adolescents. It does not focus on screening for other mental health disorders. The USPTF recommends a list of factors that healthcare professionals can use to identify high-risk children and adolescents. The list includes: family history of depression, obesity, female gender, uncertainty about sexual orientation, low socioeconomic households, and abuse. These are all components that are normally detected during an assessment. However, the USPTF does recommend screening all children and adolescents regardless of high-risk factors. 

Several screening tools are available for healthcare professionals to utilize during the assessment of a child or adolescent for MDD. However, the two discussed and studied by the USPTF is the Patient Health Questionnaire for Adolescents (PHQ-A) and the Beck’s Depression Inventory (BDI). When a healthcare professional screens for MDD in an adolescent several factors are considered. The USPTF concludes that the benefits of prevention outweigh the risks of a stigma associated with depression. It has been clinically proven that the earlier in age the onset of MDD the potential for worse outcomes increases. Therefore, choosing to not screen a child or adolescents for MDD due to the fear of creating a negative stigma regarding the client’s diagnoses of MDD is in sufficient. The PHQ-A scored the highest positive predictive value. It reported a 73% sensitivity and specificity of 94%. The results were not based on age, sex, nor ethnicity. The BDI reported sensitivity ranging from 84% to 90% and specificity ranging from 81% to 86%. Therefore, USPTF has concluded that these two screening tools are effective in screening for MDD in clients under the age of 18. 

(Example of Beck's Depression Inventory used for screening for MDD in children and adolescents in the United States) 

(Example of PHQ-A used for MDD screening) 

SSRI’s are a type of anti-depressant treatment used to treat MDD. The USPTF conducted several studies on the medications and treatment measures used to treat MDD. In the study regarding fluoxetine compared with a placebo, 221 adolescents aged 12-17 years old where tested. Approximately half the adolescents where given the fluoxetine and the remainder received the placebo. Another study was conducted regarding escitalopram in adolescents 13-14 years of age. There were 316 adolescents involved in the study. Lastly, another study was conducted regarding citalopram with a placebo in 178 adolescent’s age 15 years old.  In all studies, the SSRIs were favored and was very significant in 2 of the trails. Whenever other symptoms such as severity or global functioning was evaluated, the SSRIs were still favored. 

Depression amongst children and adolescents is a growing concern in medical treatment. However, with newer studies and evidence based research, healthcare professionals are supplied with several effective ways to screen and treat MDD. Remember, an increase in suicide rates effects all members of society. According to the American Foundation of Suicide Prevention, in 2014 $44 billion was the estimated suicide cost in the US. With cost-containment a trending topic in healthcare, suicide prevention interventions can greatly impact those numbers. Suicide is the 10^th leading cause of death in the United States and for every suicide there is an average of 25 attempts. Therefore, a simply questionnaire could mean saving someone’s life. 

Taylor Wilson 

Below you will find the link to the evidence based article and to the American Foundation of Suicide Prevention website 

http://annals.org/article.aspx?articleid=2490528

www.afsp.org