USPSTF Recommends Depression Screening for Older Adolescents

Susan London

February 09, 2016

Providers should screen adolescents aged 12 to 18 years for major depressive disorder (MDD) when adequate systems and staff are in place to ensure proper diagnosis and treatment, the US Preventive Services Task Force (USPSTF) recommends in a new guideline.

"The USPSTF found adequate evidence that screening tests can accurately identify MDD in adolescents. It also found adequate evidence that treatment of adolescents with screen-detected MDD is associated with beneficial reductions in symptoms," Albert L. Siu, MD, MSPH, writes on behalf of the USPSTF.

There was no direct evidence on the harms of screening in primary care, the authors note, but the magnitude of harm resulting from antidepressant-related adverse events, psychotherapy, and collaborative care appears to be small to none, provided patients are closely monitored.

The new recommendation was published online simultaneously in both the Annals of Internal Medicine and Pediatrics , and updates and reaffirms a guideline issued in 2009. It is accompanied by a summary for patients.

National data suggest that up to 8% of US adolescents experience an episode of major depression in a given year. However, evidence about the benefits and harms of screening and treatment for this age group has been limited.

In drafting the guideline, Dr Siu, chairperson of the USPSTF, and colleagues drew on a simultaneously published systematic review of the evidence. The review identified five studies on the accuracy of screening for MDD in primary care and six studies on the efficacy of treatment. None of the screening studies reported benefits or harms of this practice, but screening had "reasonable accuracy" for picking up adolescents with MDD. The treatment studies evaluated psychotherapy, medications, and collaborative care models and established that some were beneficial and were not associated with significant harms.

The USPSTF concluded that adolescents aged 12 to 18 years who are screened and identified in primary care as having MDD and then treated have a reduction in symptoms and an improvement in daily functioning. They therefore recommend screening this age group when adequate systems are "in place to ensure accurate diagnosis, effective treatment, and appropriate follow-up."

They give the recommendation a grade of B, indicating there is moderate certainty that the net benefit is moderate to substantial. (Giving a grade of A would require high certainty that the net benefit is substantial.)

The USPSTF notes that several tools are available for screening this age group. The two most commonly studied are the Patient Health Questionnaire for Adolescents and the primary care version of the Beck Depression Inventory.

"The optimal interval for screening for MDD is not known. Opportunistic screening may be appropriate for adolescents, who may have infrequent health care visits," they write.

The USPSTF opted not to issue any recommendation on screening for adolescents and children aged 11 years and younger because of insufficient evidence (grade I).

In addition, they note that more research is needed to better assess the effects of screening adolescents on their health outcomes, the effect of comorbidities, the effectiveness of psychotherapy and combined-modality treatments, and the incidence of uncommon adverse events.

The USPSTF authors have disclosed no relevant financial relationships. The authors of the systematic review made the following disclosures: one coauthor reports support from the Agency for Healthcare Research and Quality and Substance Abuse and Mental Health Services Administration outside the submitted work; another coauthor reports grants from the Agency for Healthcare Research and Quality during the conduct of the study; another coauthor reports grants from the Agency for Healthcare Research and Quality during the conduct of the study; another coauthor reports other funding from the US Department of Health and Human Services and grants from the Agency for Healthcare Research and Quality during the conduct of the study. The other authors have disclosed no relevant financial relationships.

Ann Intern Med. Published online February 9, 2016. Guidelines full text, Review full text

Pediatrics. Published online February 8, 2016. Abstract

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