Holcomb Juliana M, Arauz Boudreau Alexy, Riobueno-Naylor Alexa, Haile Haregnesh, Lucke Cara M, Bergmann Paul, Joseph Bernard, Jellinek Michael, Murphy J Michael
Departments of Psychiatry.
Pediatrics, Massachusetts General Hospital, Boston, MA.
J Dev Behav Pediatr. 2021 May 1;42(4):283-290. doi: 10.1097/DBP.0000000000000890.
Screening for adolescent depression is a quality indicator for pediatric care, and the parent-completed, 17-item Pediatric Symptom Checklist's internalizing (PSC-17P-INT) subscale has been validated for this purpose. The current study assessed the feasibility of PSC-17P-INT screening, the prevalence of risk on 2 consecutive PSC-17P-INTs, and rates of behavioral health (BH) service use before and after screening.
The parent-report PSC-17 was completed on tablet devices before well-child visits (WCVs) with results instantaneously available to clinicians in the electronic health record. Billing data were used to identify adolescents with 2 consecutive WCVs and possible BH service utilization 6 months before and after their first screen.
In 2017, 1,068 adolescents (12-17 years old) were seen for a WCV, and 637 (59.6%) of them had one in 2018. Most (93.9%; N = 604) completed a PSC at both visits. Patients who scored positively on their first PSC-17P-INT were about 9 times more likely to receive subsequent BH services than patients who screened negative (24.3% vs 2.6%, χ2 = 59.65, p < 0.001). However, risk prevalence increased from the first (11.6%) to the second (14.9%) screen, and only 37.1% of at-risk patients remitted.
The current study demonstrated that screening adolescents for depression using the PSC-17P-INT was feasible and associated with a significant increase in BH treatment rates. The study also demonstrated that the PSC could be used to track adolescents at risk for depression, found that most youth who screened positive remained at risk 1 year later, and supported recent quality guidelines calling for annual depression screening and follow-up for adolescents with depression.
青少年抑郁症筛查是儿科护理的一项质量指标，家长完成的17项儿科症状清单内化（PSC - 17P - INT）子量表已为此目的得到验证。本研究评估了PSC - 17P - INT筛查的可行性、连续两次PSC - 17P - INT筛查的风险患病率以及筛查前后行为健康（BH）服务的使用率。
在儿童健康检查（WCV）前，通过平板电脑设备完成家长报告的PSC - 17，结果可在电子健康记录中即时提供给临床医生。计费数据用于识别有连续两次WCV且在首次筛查前后6个月可能使用BH服务的青少年。
2017年，1068名青少年（12 - 17岁）接受了WCV检查，其中637名（59.6%）在2018年又接受了一次检查。大多数（93.9%；N = 604）在两次就诊时都完成了PSC检查。首次PSC - 17P - INT筛查呈阳性的患者接受后续BH服务的可能性比筛查阴性的患者高约9倍（24.3%对2.6%，χ2 = 59.65，p < 0.001）。然而，风险患病率从首次筛查（11.6%）增加到第二次筛查（14.9%），且只有37.1%的高危患者症状缓解。
本研究表明，使用PSC - 17P - INT对青少年进行抑郁症筛查是可行的，且与BH治疗率的显著提高相关。该研究还表明，PSC可用于追踪有抑郁症风险的青少年，发现大多数筛查呈阳性的青少年在1年后仍有风险，并支持最近要求对青少年进行年度抑郁症筛查和对抑郁症青少年进行随访的质量指南。
