Screening for Depression at Pediatric Well-Child Visits: What Happens After?

Background/Significance:

In 2021, the American Academy of Pediatrics (AAP) recommended screening for depression at annual well-visits due to the rapidly rising rate of adolescent depression. While many healthcare systems, including Advocate Health, have adopted this policy, it is unclear whether the implementation of this practice was successful. Moreover, even less is known about what follow-up action is taken for youth with elevated symptoms of depression.

Purpose:

We examined the rate of completed depression screenings at annual adolescent well-visits, as well as patient characteristics associated with variations in depression screening rate, scores, and follow-up care.

Methods:

We collected electronic medical record data from Advocate Health between 2019–2022 for youth patients aged 12–17. We defined completed depression screening as the documentation of a completed two- or nine-item version of the Patient Health Questionnaire (PHQ-2; PHQ-9). We used chi-square to test for differences in depression screening rates within demographic subgroups, and we also used logistic regression to examine the odds that patients received a depression-related follow-up action (i.e., new depression diagnosis, new antidepressant prescription, and/or referral to behavioral health services) within six months of a completed depression screening.

Results:

Overall, 86.7% of patients (N = 52,059) were screened for depression at their index annual well-visit. The rate of depression screening significantly varied based on patients’ age (χ2 = 172.1, p < 0.001), insurance type (χ2 = 183.8, p < 0.001), and race/ethnicity (χ2 = 57.3, p < 0.001). There were no significant differences in depression screening rate based on patients’ sex (χ2 =0.3, p = 0.58). Adolescents who were screened for depression had significantly greater odds of receiving depression-related action compared to those who were not screened (OR = 1.3, 95% CI [1.17, 1.51]). Additionally, youth who scored “high” on the PHQ-9 (10+) had significantly greater odds of receiving depression-related action compared to those who scored “low” (OR = 5.17, 95% CI [4.56, 5.87]).

Conclusion:

Consistent with AAP guidelines, depression screenings were completed at a high rate at adolescent well-visits. Our results also indicate providers acted upon the screening results in a timely manner when patients were identified as at-risk for having depression. Still, further research is needed to examine the effectiveness of follow-up care for youth with elevated depressive symptoms.