Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland.
Data Science Research and Development, Highmark Health, Pittsburgh, Pennsylvania.
Am J Prev Med. 2022 Apr;62(4):511-518. doi: 10.1016/j.amepre.2021.09.008. Epub 2021 Nov 17.
Depression screening is universally recommended for adolescents presenting in primary care settings in the U.S. However, little is known about how depression screening affects the likelihood of being diagnosed with a mental disorder or accessing mental health care over time.
This longitudinal cohort study used insurance claims data from adolescents who attended a well-visit between 2014 and 2017. Propensity score matching was used to compare adolescents who were screened for depression with similar unscreened adolescents. Diagnoses and treatment uptake were examined over a 6-month follow-up and included depression diagnoses, mood-related diagnoses, antidepressant medications, any mental health medication, and psychotherapy. Heterogeneity of associations by sex was also examined. Analyses were conducted from December 2020 to June 2021.
The sample included 57,732 adolescents (mean age, 14.26 years; 48.9% female). Compared with adolescents who were not screened for depression, adolescents screened for depression were 30% more likely to be diagnosed with depression (risk ratio=1.30, 95% CI=1.11, 1.52) and 17% more likely to receive a mood-related diagnosis (risk ratio=1.17, 95% CI=1.08, 1.27) but were not more likely to be treated with an antidepressant medication (risk ratio=1.11, 95% CI=0.82, 1.51), any mental health medication (risk ratio=1.15, 95% CI=0.87, 1.53), or psychotherapy (risk ratio=1.13, 95% CI=0.98, 1.31). Associations were generally stronger among female adolescents.
Adolescents who were screened for depression during a well-visit were more likely to receive a diagnosis of depression or a mood-related disorder in the 6 months after screening. Future research should explore methods for increasing treatment uptake after screening.
在美国，普遍建议在初级保健环境中为出现的青少年进行抑郁筛查。然而，对于抑郁筛查如何影响随着时间的推移被诊断为精神障碍或获得精神保健的可能性，人们知之甚少。
本纵向队列研究使用了 2014 年至 2017 年期间参加健康检查的青少年的保险索赔数据。采用倾向评分匹配比较了接受抑郁筛查的青少年与相似的未筛查青少年。在 6 个月的随访期间，检查了诊断和治疗情况，包括抑郁诊断、与情绪相关的诊断、抗抑郁药物、任何精神健康药物和心理治疗。还检查了性别差异的相关性。分析于 2020 年 12 月至 2021 年 6 月进行。
该样本包括 57732 名青少年（平均年龄 14.26 岁；48.9%为女性）。与未接受抑郁筛查的青少年相比，接受抑郁筛查的青少年被诊断为抑郁的可能性高 30%（风险比=1.30，95%CI=1.11，1.52），被诊断为与情绪相关的疾病的可能性高 17%（风险比=1.17，95%CI=1.08，1.27），但不太可能接受抗抑郁药物治疗（风险比=1.11，95%CI=0.82，1.51）、任何精神健康药物（风险比=1.15，95%CI=0.87，1.53）或心理治疗（风险比=1.13，95%CI=0.98，1.31）。这些关联在女性青少年中通常更强。
在健康检查期间接受抑郁筛查的青少年在筛查后 6 个月内更有可能被诊断为抑郁症或与情绪相关的疾病。未来的研究应探索在筛查后增加治疗效果的方法。
