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AAP Grand Rounds 20:55 (2008) Screening for Adolescent Depression in the EDSource: Biros MH, Hick K, Cen Yym, et al. Occult depressive symptoms in adolescent emergency department patients. Arch Pediatr Adolesc Med. 2008;162(8):769–773; doi:10.1001/archpedi.162.8.769
Researchers from Hennepin County Medical Center in Minneapolis, MN, and the Children’s Hospitals and Clinics of Minnesota sought to determine the prevalence of unsuspected depression in adolescents aged 13–17 years seeking care at one of three emergency departments (EDs). A convenience sample of patients were enrolled during high patient flow evening hours if they had acute non-psychiatric medical concerns, could read and speak English, and were medically stable. The patient’s parent or guardian was asked to complete a demographic survey and assessment of whether the patient was depressed. Patients completed a questionnaire about activities (organized social activities, sexual relationships), lifestyle (tobacco, alcohol, and street drug use), and whether the patient thought he/she was depressed. Patients were also administered the Beck Depression Inventory II (BDII) which consists of 21 multiple-choice screening questions. Patients were told to complete the screening tool based on their feelings over the preceding two weeks. Patients and guardians were told that the patients’ BDII results but not the questionnaires would be shared with the guardian. A total of 2,150 patients were screened, from which 967 patients were enrolled (508 from Hennepin County and 459 from the combined children’s hospitals). BDII screening results showed that 12% (115/967) of adolescents had symptoms of moderate depression and 8% (82/967) had symptoms of severe depression. Depression was acknowledged by 58% (115/197) of the patients with moderate to severe depression while only 50% of the guardians of these patients believed the patient was currently depressed. In only 33% (77/197) of the patients with moderate to severe depression was depression recognized by both the patient and guardian. Multiple logistic regression analysis revealed several risk factors associated with a positive screen on BDII including female gender, use of street drugs, knowledge of someone who has hurt himself/herself intentionally, lack of involvement in organized social activities, knowledge of someone who had died a violent death, and current involvement in a sexual relationship. The authors conclude that ED screening for depression may identify adolescents in need of additional resources and services.
Dr. Paul has disclosed no financial relationship relevant to this commentary. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device. The prevalence of adolescent depression has been reported to be as high as 18%.1 Despite the high prevalence, many adolescents are not identified and treated for depression due to lack of recognizable symptoms.2 Frequently, an adolescent’s only source of care is at an ED when he or she experiences an injury or acute medical illness. EDs may be the only opportunity for depression screening of this age group. In this study, 20% of study patients presenting to the ED for acute non-psychiatric conditions were identified with moderate to severe depression, and a third of those were unrecognized by either the adolescent or the guardian. Safe and effective treatment of depression requires accurate diagnosis. Systematic tools to identify depression have been recommended for primary care physicians to increase their recognition of adolescent depression.3 EDs are increasingly thrust into serving as a safety net for mental health issues as community resources have diminished.4 Despite the chaotic environment of the ED, screening for adolescent depression may be administered by non-physician members of the health care team during acute care visits. Adolescents with vague somatic complaints and normal examinations may warrant administration of a formal evaluation for a mental health disorder. Having a reliable tool to screen for depression may prevent unnecessary medical evaluations and ensure timely referrals for mental health evaluation and treatment.
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