Wright Davene R, Katon Wayne J, Ludman Evette, McCauley Elizabeth, Oliver Malia, Lindenbaum Jeffrey, Richardson Laura P
Department of Pediatrics, University of Washington School of Medicine, Seattle, Wash; Seattle Children's Research Institute Center for Child Health, Behavior, and Development, Seattle, Wash.
Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, Wash.
Acad Pediatr. 2016 Jan-Feb;16(1):82-9. doi: 10.1016/j.acap.2015.08.013. Epub 2015 Oct 9.
Screening adolescents for depression is recommended by the US Preventive Services Task Force. We sought to evaluate the impact of positive depression screens in an adolescent population on health care utilization and costs from a payer perspective.
We conducted depression screening among 13- to 17-year-old adolescents enrolled in a large integrated care system using the 2- and 9-item Patient Health Questionnaires (PHQ). Health care utilization and cost data were obtained from administrative records. Chi-square, Wilcoxon rank sum, and t tests were used to test for statistical differences in outcomes between adolescents on the basis of screening status.
Of the 4010 adolescents who completed depression screening, 3707 (92.4%) screened negative (PHQ-2 <2 or PHQ-9 <10), 186 (3.9%) screened positive for mild depression (PHQ-9 10-14), and 95 (2.4%) screened positive for moderate to severe depression (PHQ-9 ≥15). In the 12 months after screening, screen-positive adolescents were more likely than screen-negative adolescents to receive any emergency department visit or inpatient hospitalization, and they had significantly higher utilization of outpatient medical (mean ± SD, 8.3 ± 1.5 vs 3.5 ± 5.1) and mental health (3.8 ± 9.3 vs 0.7 ± 3.5) visits. Total health care system costs for screen-positive adolescents ($5083 ± $10,489) were more than twice as high as those of screen-negative adolescents ($2357 ± $7621).
Adolescent depressive symptoms, even when mild, are associated with increased health care utilization and costs. Only a minority of the increased costs is attributable to mental health care. Implementing depression screening and evidence-based mental health services may help to better control health care costs among screen-positive adolescents.
美国预防服务工作组建议对青少年进行抑郁症筛查。我们试图从支付方的角度评估青少年人群中抑郁症筛查呈阳性对医疗保健利用和成本的影响。
我们使用2项和9项患者健康问卷（PHQ）对纳入大型综合医疗系统的13至17岁青少年进行抑郁症筛查。医疗保健利用和成本数据来自行政记录。采用卡方检验、威尔科克森秩和检验和t检验来检验基于筛查状态的青少年在结局方面的统计学差异。
在完成抑郁症筛查的4010名青少年中，3707名（92.4%）筛查为阴性（PHQ-2<2或PHQ-9<10），186名（3.9%）筛查为轻度抑郁症阳性（PHQ-9为10-14），95名（2.4%）筛查为中度至重度抑郁症阳性（PHQ-9≥15）。在筛查后的12个月内，筛查呈阳性的青少年比筛查呈阴性的青少年更有可能接受任何急诊科就诊或住院治疗，并且他们在门诊医疗（均值±标准差，8.3±1.5对3.5±5.1）和心理健康（3.8±9.3对0.7±3.5）就诊方面的利用率显著更高。筛查呈阳性的青少年的医疗保健系统总成本（5083美元±10489美元）是筛查呈阴性的青少年（2357美元±7621美元）的两倍多。
青少年抑郁症状，即使是轻度的，也与医疗保健利用率和成本增加有关。增加的成本中只有一小部分可归因于心理健康护理。实施抑郁症筛查和循证心理健康服务可能有助于更好地控制筛查呈阳性的青少年的医疗保健成本。
