Division of Primary Care Pediatrics
Department of Pediatrics, College of Medicine.
Pediatrics. 2021 Jul;148(1). doi: 10.1542/peds.2021-049999. Epub 2021 Jun 7.
Depression is common, and suicide rates are increasing. Adolescent depression screening might miss those with unidentified suicide risk. Our primary objective in this study was to compare the magnitude of positive screen results across different approaches.
From June 2019 to October 2020, 803 mostly Medicaid-enrolled adolescents aged ≥12 years with no recent history of depression or self-harm were screened with the Patient Health Questionnaire-9 Modified for Adolescents (PHQ-9A) and the Ask Suicide-Screening Questions (ASQ) across 12 primary care practices. Two PHQ-9A screening strategies were evaluated: screening for any type of depression or other mental illness (positive on any item) or screening for major depressive disorder (MDD) (total score ≥10).
Overall, 56.4% of patients screened positive for any type of depression, 24.7% screened positive for MDD, and 21.1% screened positive for suicide risk. Regardless of PHQ-9A screening strategy, the ASQ identified additional subjects (eg, 2.2% additional cases compared with screening for any type of depression or other mental illness and 8.3% additional cases compared with screening positive for MDD). Of those with ≥6 month follow-up, 22.9% screened positive for any type of depression ( = 205), 35.6% screened positive for MDD ( = 90), and 42.7% with a positive ASQ result ( = 75) had a depression or self-harm diagnosis or an antidepressant prescription.
Suicide risk screening identifies cases not identified by depression screening. In this study, we underscore opportunities and challenges in primary care related to the high prevalence of depression and suicide risk. Research is needed regarding optimal screening strategies and to help clinicians manage the expected number of screening-identified adolescents.
抑郁症较为常见，且自杀率呈上升趋势。青少年抑郁症筛查可能会遗漏那些具有未被识别的自杀风险的患者。本研究的主要目的是比较不同方法得出的阳性筛查结果的幅度。
2019 年 6 月至 2020 年 10 月，我们在 12 家初级保健机构中对 803 名主要由医疗补助计划覆盖的、年龄≥12 岁且近期无抑郁或自伤史的青少年进行了青少年患者健康问卷-9 项修订版（Patient Health Questionnaire-9 Modified for Adolescents，PHQ-9A）和自杀筛查问题（Ask Suicide-Screening Questions，ASQ）筛查。评估了两种 PHQ-9A 筛查策略：筛查任何类型的抑郁或其他精神疾病（任何项目阳性）或筛查重性抑郁障碍（major depressive disorder，MDD）（总分≥10）。
总体而言，56.4%的患者筛查出任何类型的抑郁，24.7%筛查出 MDD，21.1%筛查出自杀风险。无论采用何种 PHQ-9A 筛查策略，ASQ 都能识别出更多的对象（例如，与筛查任何类型的抑郁或其他精神疾病相比，额外识别出 2.2%的病例，与筛查 MDD 阳性相比，额外识别出 8.3%的病例）。在有≥6 个月随访的患者中，22.9%筛查出任何类型的抑郁（=205），35.6%筛查出 MDD（=90），42.7%ASQ 结果阳性（=75）的患者有抑郁或自伤诊断或抗抑郁药处方。
自杀风险筛查可以识别出抑郁筛查无法识别的病例。在本研究中，我们强调了在初级保健中与高患病率的抑郁和自杀风险相关的机会和挑战。需要开展关于最佳筛查策略的研究，以帮助临床医生管理预计数量的筛查识别出的青少年。
