Department of Pediatrics, Monmouth Medical Center, Long Branch, New Jersey, USA
Department of Pediatrics, Monmouth Medical Center, Long Branch, New Jersey, USA.
BMJ Open Qual. 2020 Oct;9(4). doi: 10.1136/bmjoq-2019-000751.
Depression, which is a serious medical illness, is prevalent worldwide and it negatively impacts the adolescent lifestyle. Adolescent depression is associated with adverse emotional and functional outcomes and suboptimal physical health. Over the last decade, it has been found that approximately 9% of teenagers meet the criteria for depression at any given time, and one in five teenagers have a history of depression during adolescence. Ninety per cent of paediatricians believe that recognition of child and adolescent depression is their responsibility; however, it has been reported that 46% lacked confidence that they could recognise depression.
In this study, adolescents between 12 and 17 years of age were screened during their well-child visits using the Patient Health Questionnaire Modified for Adolescents. A score of 10 or higher warrants a referral to a social worker and psychiatrist. The goals of this quality improvement project were to implement a standardised questionnaire and to improve the screening, diagnosis and treatment of depression in children from 12 to 17 years of age.
It was found that the adolescent depression screening rate significantly improved within 6 months of implementing this quality improvement project. The screening rate improved to 50% by mid-cycle (Plan-Do-Study-Act (PDSA) cycle 3) and up to 70% at the end of the 6-month period (PDSA cycle 5). Improvement was noted among all providers, across all age groups, and in both male and female patients by the end of the study period.
Standardised screening tests with a scoring system help providers to identify and monitor depression symptoms using a common language, especially in the outpatient clinical setting where the patient may be seen by different providers.
抑郁症是一种严重的医学疾病，在全球范围内普遍存在，它对青少年的生活方式产生负面影响。青少年抑郁症与不良的情绪和功能结果以及身体不健康有关。在过去的十年中，发现大约有 9%的青少年在任何特定时间都符合抑郁症的标准，并且有五分之一的青少年在青春期有过抑郁症病史。90%的儿科医生认为识别儿童和青少年的抑郁症是他们的责任；然而，据报道，有 46%的人缺乏识别抑郁症的信心。
在这项研究中，在青少年进行常规儿童就诊时，使用青少年患者健康问卷改良版对他们进行了筛查。如果得分达到 10 分或更高，则需要转介给社会工作者和精神科医生。这个质量改进项目的目标是实施标准化问卷，并改善对 12 至 17 岁儿童的抑郁症的筛查、诊断和治疗。
实施该质量改进项目后 6 个月内，青少年抑郁症的筛查率显著提高。筛查率在中期提高到 50%（计划-执行-研究-行动（PDSA）循环 3），在 6 个月结束时提高到 70%（PDSA 循环 5）。在研究结束时，所有提供者、所有年龄段以及男性和女性患者中都注意到了这种改善。
标准化的筛查测试和评分系统有助于提供者使用共同的语言识别和监测抑郁症状，特别是在门诊临床环境中，患者可能会由不同的提供者就诊。
