Departments of Pediatrics, University of Washington School of Medicine, Seattle, WA 98121, USA.
Pediatrics. 2012 Dec;130(6):e1541-8. doi: 10.1542/peds.2012-0450. Epub 2012 Nov 19.
To examine predictors of depression persistence after a positive screening test to inform management protocols for screened youth.
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.
Of 113 youth with a positive baseline screen (PHQ-9 ≥11), 47% and 35% continued to be positive at 6-week and 6-month follow-up, 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).
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.
探讨抑郁筛查呈阳性后的抑郁持续存在的预测因素，为筛查后青少年的管理方案提供依据。
我们对来自大型医疗服务系统的 444 名青少年（年龄 13-17 岁）进行了队列研究。根据 2 项抑郁筛查，对有抑郁症状的青少年进行了基线访谈的超额抽样。基线评估包括患者健康问卷 9 项（PHQ-9）抑郁筛查以及假设影响抑郁持续存在的临床因素（抑郁家族史、功能障碍、感知社会支持、焦虑症状、外化症状和合并症）。采用逻辑回归分析来检查与基线后 6 个月抑郁持续存在相关的因素。
在 113 名基线筛查阳性（PHQ-9≥11）的青少年中，分别有 47%和 35%在 6 周和 6 个月随访时仍为阳性。在控制治疗状态后，仅有 2 个因素与 6 个月时的抑郁持续存在显著相关：基线抑郁症状评分和 6 周时仍为阳性的筛查。PHQ-9 基线评分每增加 1 分，青少年在 6 个月时继续抑郁的几率增加 16%（比值比：1.16，95%置信区间：1.01-1.34）。6 周后继续筛查阳性的青少年在 6 个月时抑郁的几率几乎增加了 3 倍（比值比：2.89，95%置信区间：1.09-7.61）。
就诊时的抑郁症状严重程度和筛查后 6 周的持续症状是抑郁持续存在的最强预测因素。PHQ-9 评分高且 6 周后持续存在症状的患者应接受积极治疗。
