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Close J, Arshad SH, Soffer SL, Lewis J, Benton TD. Adolescent Health in the Post-Pandemic Era: Evolving Stressors, Interventions, and Prevention Strategies amid Rising Depression and Suicidality. Pediatr Clin North Am 2024; 71:583-600. [PMID: 39003003 DOI: 10.1016/j.pcl.2024.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/15/2024]
Abstract
Prior to COVID-19, there were already increasing rates of youth with mental health concerns, including an increase in youth presenting to medical emergency departments (EDs) with mental health chief complaints and limited access to treatment. This trend worsened during the pandemic, and rates of youth presenting to medical EDs with suicidal ideation and self-harm increased 50% from 2019 to 2022. This resulted in a "boarding" crisis, in part, due to a lack of inpatient psychiatric hospitalization beds, and many youth were left without access to adequate treatment. Additional study of innovations in health care delivery will be paramount in meeting this need.
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Affiliation(s)
- Jeylan Close
- National Clinician Scholars Program, Department of Psychiatry and Behavioral Sciences, Child & Family Mental Health & Community Psychiatry Division, Duke University School of Medicine, 710 West Main Street, Durham, NC 27701, USA; Duke Margolis Center for Health Policy, Duke University, 710 West Main Street, Durham, NC 27701, USA.
| | - Sarah H Arshad
- Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine and UC Irvine School of Medicine, The Hub for Clinical Collaboration, DCAPBS, Floor 12, 3500 Civic Center Boulevard, Philadelphia, PA 19104, USA
| | - Stephen L Soffer
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia and University of Pennsylvania Perelman School of Medicine, 4601 Market Street, 3rd Floor, Philadelphia, PA 19139, USA
| | - Jason Lewis
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia and University of Pennsylvania Perelman School of Medicine, 4601 Market Street, 3rd Floor, Philadelphia, PA 19139, USA
| | - Tami D Benton
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia and University of Pennsylvania Perelman School of Medicine, 4601 Market Street, 3rd Floor, Philadelphia, PA 19139, USA
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DelFerro J, Whelihan J, Min J, Powell M, DiFiore G, Gzesh A, Jelinek S, Schwartz KTG, Davis M, Jones JD, Fiks AG, Jenssen BP, Wood S. The Role of Family Support in Moderating Mental Health Outcomes for LGBTQ+ Youth in Primary Care. JAMA Pediatr 2024:2820609. [PMID: 38949835 PMCID: PMC11217892 DOI: 10.1001/jamapediatrics.2024.1956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Accepted: 05/03/2024] [Indexed: 07/02/2024]
Abstract
Importance Lesbian, gay, bisexual, transgender, queer, and/or questioning (LGBTQ+) youth face worse mental health outcomes than non-LGBTQ+ peers. Family support may mitigate this, but sparse evidence demonstrates this in clinical settings. Objectives To compare depression and suicide risk between LGBTQ+ and non-LGBTQ+ youth in primary care settings and to investigate whether family support mitigates these negative mental health outcomes. Design, Setting, and Participants This cross-sectional study uses data from well care visits completed by adolescents aged 13 to 19 years from February 2022 through May 2023, including the Patient Health Questionnaire-9 Modified for Teens (PHQ-9-M) and the Adolescent Health Questionnaire (AHQ; an electronic screener assessing identity, behaviors, and guardian support), at 32 urban or suburban care clinics in Pennsylvania and New Jersey. Exposures The primary exposure was self-reported LGBTQ+ status. Family support moderators included parental discussion of adolescent strengths and listening to feelings. Race and ethnicity (determined via parent or guardian report at visit check-in), sex, payer, language, age, and geography were covariates. Main Outcomes and Measures PHQ-9-M-derived mental health outcomes, including total score, recent suicidal ideation, and past suicide attempt. Results The sample included 60 626 adolescents; among them, 9936 (16.4%) were LGBTQ+, 15 387 (25.5%) were Black, and 30 296 (50.0%) were assigned female sex at birth. LGBTQ+ youth, compared with non-LGBTQ+ youth, had significantly higher median (IQR) PHQ-9-M scores (5 [2-9] vs 1 [0-3]; P < .001) and prevalence of suicidal ideation (1568 [15.8%] vs 1723 [3.4%]; P < .001). Fewer LGBTQ+ youth endorsed parental support than non-LGBTQ+ youth (discussion of strengths, 8535 [85.9%] vs 47 003 [92.7%]; P < .001; and listening to feelings, 7930 [79.8%] vs 47 177 [93.1%]; P < .001). In linear regression adjusted for demographic characteristics and parental discussion of strengths, LGBTQ+ status was associated with a higher PHQ-9-M score (mean difference, 3.3 points; 95% CI, 3.2-3.3 points). In logistic regression, LGBTQ+ youth had increased adjusted odds of suicidal ideation (adjusted odds ratio, 4.3; 95% CI, 4.0-4.7) and prior suicide attempt (adjusted odds ratio, 4.4; 95% CI, 4.0-4.7). Parental support significantly moderated the association of LGBTQ+ status with PHQ-9-M score and suicidal ideation, with greater protection against these outcomes for LGBTQ+ vs non-LGBTQ+ youth. Conclusions and Relevance Compared with non-LGBTQ+ youth, LGBTQ+ youth at primary care visits had more depressive symptoms and higher odds of suicidal ideation and prior suicide attempt. Youth-reported parental support was protective against these outcomes, suggesting potential benefits of family support-focused interventions to mitigate mental health inequities for LGBTQ+ youth.
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Affiliation(s)
- Joseph DelFerro
- Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Joseph Whelihan
- Pediatric Residency Program, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
- Clinical Futures and PolicyLab, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
- Craig Dalsimer Division of Adolescent Medicine, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Jungwon Min
- Clinical Futures and PolicyLab, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
- Data Science and Biostatistics Unit, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Maura Powell
- Clinical Futures and PolicyLab, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Gabrielle DiFiore
- Clinical Futures and PolicyLab, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Ari Gzesh
- Craig Dalsimer Division of Adolescent Medicine, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Scott Jelinek
- Perelman School of Medicine, University of Pennsylvania, Philadelphia
- Craig Dalsimer Division of Adolescent Medicine, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Karen T. G. Schwartz
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Molly Davis
- Perelman School of Medicine, University of Pennsylvania, Philadelphia
- Clinical Futures and PolicyLab, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
- Leonard Davis Institute for Health Economics, University of Pennsylvania, Philadelphia
| | - Jason D. Jones
- Perelman School of Medicine, University of Pennsylvania, Philadelphia
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Alexander G. Fiks
- Perelman School of Medicine, University of Pennsylvania, Philadelphia
- Clinical Futures and PolicyLab, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
- Leonard Davis Institute for Health Economics, University of Pennsylvania, Philadelphia
| | - Brian P. Jenssen
- Perelman School of Medicine, University of Pennsylvania, Philadelphia
- Clinical Futures and PolicyLab, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
- Leonard Davis Institute for Health Economics, University of Pennsylvania, Philadelphia
| | - Sarah Wood
- Perelman School of Medicine, University of Pennsylvania, Philadelphia
- Clinical Futures and PolicyLab, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
- Craig Dalsimer Division of Adolescent Medicine, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
- Leonard Davis Institute for Health Economics, University of Pennsylvania, Philadelphia
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Catanzano AA, Bastrom TP, Bartley CE, Yaszay B, Upasani VV, Newton PO. Depression Screening in Pediatric Orthopedic Surgery Clinics and Identifying Patients At-Risk. J Pediatr Orthop 2024; 44:291-296. [PMID: 38311830 DOI: 10.1097/bpo.0000000000002635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2024]
Abstract
BACKGROUND Up to 25% of youth experience a depressive episode by 18 years of age, leading the US Preventive Services Task Force to recommend depression screening within this population. This study aimed to understand the prevalence of depression identified within pediatric orthopedic clinics compared with primary care clinics after the implementation of a screening program and present data on the prevalence of moderate-severe depression across specific pediatric orthopedic clinics, characterizing and identifying specific populations at higher risk. METHODS A retrospective review was performed to identify all patients screened using the 2-item and 9-item versions of the Patient Health Questionnaire (PHQ-2/PHQ-9) and the Columbia-Suicide Severity Rating Scale over a 2-year period (October 2018 to January 2021) within pediatric primary care and orthopaedic clinics. Demographic and clinical characteristics were collected. Statistical analysis was performed to compare scores between orthopedic and primary care clinics, as well as between the different pediatric orthopedic subspecialties and included χ 2 test, ANOVA, and logistic regression. RESULTS There were 32,787 unique adolescent patients screened in primary care clinics, with an additional 14,078 unique adolescent patients screened in orthopaedic clinics, leading to a 30% increase in the overall number of patients receiving depression screening. 5.2% of patients in primary care pediatric clinics screened positive for moderate-severe depression versus 2.0% in pediatric orthopaedic clinics ( P <0.001). 2.7% of primary care patients were at risk of self-harm compared with 0.8% of orthopedic patients ( P <0.001). Within orthopaedic subspecialty clinics, the spine patients were at the highest risk of moderate-severe depression (3.5%), significantly higher than both the sports (1.4%, P =0.006) and patients with acute fracture (1.3%, P <0.001). CONCLUSIONS This study demonstrates the high incidence of patients screening positive for depression in pediatric and adolescent orthopaedic clinics. By identifying high-risk clinics and patient groups, health care systems can apply a more practical approach and appropriately deploy behavioral health specialists for timely counseling and treatment discussions. LEVEL OF EVIDENCE Level-III.
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Affiliation(s)
- Anthony A Catanzano
- Department of Orthopaedics, Duke Children's Hospital and Health Center, Durham, NC
| | - Tracey P Bastrom
- Division of Orthopaedics and Scoliosis, Rady Children's Hospital, San Diego, CA
| | - Carrie E Bartley
- Division of Orthopaedics and Scoliosis, Rady Children's Hospital, San Diego, CA
| | - Burt Yaszay
- Department of Orthopaedics and Sports Medicine, Seattle Children's Hospital, Seattle, WA
| | - Vidyadhar V Upasani
- Division of Orthopaedics and Scoliosis, Rady Children's Hospital, San Diego, CA
- Department of Orthopaedics, University of California, San Diego, CA
| | - Peter O Newton
- Division of Orthopaedics and Scoliosis, Rady Children's Hospital, San Diego, CA
- Department of Orthopaedics, University of California, San Diego, CA
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Davis M, Jones JD, Schwartz KTG, Dysart G, So A, Young JF. Emerging Risk of Adolescent Depression and Suicide Detected Through Pediatric Primary Care Screening. J Pediatr Psychol 2024; 49:111-119. [PMID: 38001561 DOI: 10.1093/jpepsy/jsad088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 11/09/2023] [Accepted: 11/09/2023] [Indexed: 11/26/2023] Open
Abstract
OBJECTIVE The goal of the current study was to document patterns of stability and change in adolescent depression and suicide risk detected via universal depression screening in pediatric primary care and to determine who may go on to experience emerging risk. METHODS Retrospective electronic health record information (sociodemographic data and depression screening results for 2 timepoints) was extracted for adolescents aged 12-17 who attended well-visits between November 15, 2017, and February 1, 2020, in a large pediatric primary care network. A total of 27,335 adolescents with 2 completed depression screeners were included in the current study. RESULTS While most adolescents remained at low risk for depression and suicide across the 2 timepoints, others experienced emerging risk (i.e., low risk at time 1 but elevated risk at time 2), decreasing risk (i.e., high risk at time 1 but low risk at time 2) or stable high risk for depression or suicide. Odds of experiencing emerging depression and suicide risk were higher among adolescents who were female (compared to males), Black (compared to White), and had Medicaid insurance (compared to private insurance). Odds of experiencing emerging depression risk were also higher among older adolescents (compared to younger adolescents) as well as adolescents who identified as Hispanic/Latino (compared to non-Hispanic/Latino). CONCLUSIONS Findings can inform symptom monitoring and opportunities for prevention in primary care.
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Affiliation(s)
- Molly Davis
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, USA
- PolicyLab, Children's Hospital of Philadelphia, USA
- Clinical Futures, Children's Hospital of Philadelphia, USA
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, USA
- Penn Implementation Science Center at the Leonard Davis Institute of Health Economics (PISCE@LDI), University of Pennsylvania, USA
| | - Jason D Jones
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, USA
- PolicyLab, Children's Hospital of Philadelphia, USA
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, USA
| | - Karen T G Schwartz
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, USA
- PolicyLab, Children's Hospital of Philadelphia, USA
| | - Gillian Dysart
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, USA
- PolicyLab, Children's Hospital of Philadelphia, USA
| | - Amy So
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, USA
- PolicyLab, Children's Hospital of Philadelphia, USA
| | - Jami F Young
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, USA
- PolicyLab, Children's Hospital of Philadelphia, USA
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, USA
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Davis M, Jones JD, Gallop R, So A, Dysart G, Young JF. Adolescent Depression Symptom Trajectories Detected Via Universal Screening in Pediatric Primary Care. Res Child Adolesc Psychopathol 2024; 52:183-194. [PMID: 37642920 DOI: 10.1007/s10802-023-01116-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/21/2023] [Indexed: 08/31/2023]
Abstract
Unique trajectories of adolescent depression symptoms have been identified, yet less is known about whether such patterns translate to real-world clinical settings. Because annual adolescent depression screening is becoming more prevalent in primary care, we examined whether longitudinal patterns of depression symptoms documented in the developmental psychopathology literature can also be detected via routine screening in primary care and explored how membership in the identified trajectories varied based on concurrent suicide risk and sociodemographic factors. A total of 1,359 adolescents aged 12-16 years old at the first timepoint were included in the current analyses. These adolescents completed three depression screeners during their well-visits in a large pediatric primary care network between November 15, 2017 and February 1, 2020. Retrospective electronic health record data were extracted, including sociodemographic variables and depression screening results. Dynamic functional time series clustering results indicated the optimal number of clusters was five. The five depression symptom trajectories were: (1) A-Shaped (i.e., relatively low depression symptoms at Time 1, a substantial increase in symptoms at Time 2, and a return to low symptoms at Time 3), (2) Increasing, (3) Low-Stable, (4) High-Decreasing, and (5) Low-Decreasing. Cluster differences in suicide risk largely mapped onto depression symptom levels at each assessment. We found cluster differences based on practice location, insurance type, and adolescent race. The symptom trajectories observed in this study resemble those found in the developmental psychopathology literature, though some key differences were noted. Findings can inform future research and symptom monitoring in primary care.
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Affiliation(s)
- Molly Davis
- Department of Child and Adolescent Psychiatry and Behavioral Sciences and PolicyLab, Children's Hospital of Philadelphia, Philadelphia, PA, USA.
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.
- Penn Implementation Science Center at the Leonard Davis Institute of Health Economics (PISCE@LDI), University of Pennsylvania, Philadelphia, PA, USA.
| | - Jason D Jones
- Department of Child and Adolescent Psychiatry and Behavioral Sciences and PolicyLab, Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Robert Gallop
- Department of Mathematics, West Chester University, West Chester, PA, USA
| | - Amy So
- Department of Child and Adolescent Psychiatry and Behavioral Sciences and PolicyLab, Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Psychology Department at Montclair State University, Montclair, NJ, USA
| | - Gillian Dysart
- Department of Child and Adolescent Psychiatry and Behavioral Sciences and PolicyLab, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Jami F Young
- Department of Child and Adolescent Psychiatry and Behavioral Sciences and PolicyLab, Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
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Bruni T, Smith S, Quigley J, Koval E, LaLonde L, Maragakis A, Kilbourne AM, King C, Orringer K, Lee JM. Real-World Depression Screening Practices Among Primary Care Providers Across Patient-Level and Provider-Level Characteristics. Clin Pediatr (Phila) 2024:99228231223782. [PMID: 38279838 PMCID: PMC11282173 DOI: 10.1177/00099228231223782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2024]
Abstract
This study examined primary care provider (PCP) alignment with guideline-based care for adolescent depression screening and identified factors associated with post-screening responses. A retrospective chart review was conducted across 17 primary care clinics. Logistical regressions were estimated across provider specialties, sociodemographic factors, and patient clinical histories. Significant differences in follow-up and identification of depression were found among patients with more severe depression presentation. Follow-up screening was also more likely to be completed among patients with private insurance and less likely to occur among Black patients. Patients with significant mental health history of a mood concern, history of being prescribed psychotropic medication, were currently on medications at the time of the screening, or had a history of an internal mental health referral had a higher predicted probability of being identified as depressed on the patient problem list.
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Affiliation(s)
- Teryn Bruni
- Department of Pediatrics, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA
- Department of Psychology, Algoma University, Sault Ste., Marie, ON, Canada
| | - Shawna Smith
- School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Joanna Quigley
- Child & Adolescent Psychiatry, Michigan Medicine, Ann Arbor, MI, USA
| | | | - Leah LaLonde
- Department of Psychology, Eastern Michigan University, Ypsilanti, MI, USA
| | | | - Amy M. Kilbourne
- Department of Psychology, The American College of Greece, Athens, Greece
- VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
| | - Cheryl King
- Child & Adolescent Psychiatry, Michigan Medicine, Ann Arbor, MI, USA
| | - Kelly Orringer
- Department of Pediatrics, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Joyce M. Lee
- Department of Pediatrics, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA
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Knepper AK, Feinstein RT, Sanchez-Flack J, Fitzgibbon M, Lefaiver C, McHugh A, Gladstone TR, Van Voorhees BW. Primary care-based screening and recruitment for an adolescent depression prevention trial: Contextual considerations during a youth mental health crisis. IMPLEMENTATION RESEARCH AND PRACTICE 2024; 5:26334895241246203. [PMID: 38655380 PMCID: PMC11036909 DOI: 10.1177/26334895241246203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2024] Open
Abstract
Background Rising rates of adolescent depression in the wake of COVID-19 and a youth mental health crisis highlight the urgent need for accessible mental healthcare and prevention within primary care. Digital mental health interventions (DMHIs) may increase access for underserved populations. However, these interventions are not well studied in adolescents, nor healthcare settings. The purpose of this study was to identify barriers and facilitators to screening and recruitment activities for PATH 2 Purpose (P2P): Primary Care and Community-Based Prevention of Mental Disorders in Adolescents, a multi-site adolescent depression prevention trial comparing two digital prevention programs within four diverse health systems in two U.S. states. Method This qualitative study is a component of a larger Hybrid Type I trial. We conducted semi-structured key informant interviews with clinical and non-clinical implementers involved with screening and recruitment for the P2P trial. Informed by the Consolidated Framework for Implementation Research (CFIR), interviews were conducted at the midpoint of the trial to identify barriers, facilitators, and needed adaptations, and to gather information on determinants that may affect future implementation. Findings Respondents perceived the P2P trial as valuable, well aligned with the mission of their health systems. However, several barriers were identified, many of which stemmed from influences outside of the healthcare settings. Universal and site-specific outer setting influences (COVID-19 pandemic, youth mental health crisis, local community conditions) interacted with Inner Setting and Innovation domains to create numerous challenges to the implementation of screening and recruitment. Conclusion Our findings emphasize the need for ongoing, comprehensive assessment of dynamic inner and outer setting contexts prior to and during implementation of clinical trials, as well as flexibility for adaptation to unique clinical contexts. The CFIR is useful for assessing determinants during times of rapid inner and outer setting change, such as those brought on by the COVID-19 pandemic, youth mental health crisis, and the corresponding exacerbation of resource strain within healthcare settings. Clinical trial registration PATH 2 Purpose: Primary Care and Community-Based Prevention of Mental Disorders in Adolescents https://www.clinicaltrials.gov/study/NCT04290754.
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Affiliation(s)
- Amanda K. Knepper
- Department of Pediatrics, College of Medicine, University of Illinois Chicago, Chicago, IL, USA
| | - Rebecca T. Feinstein
- Department of Pediatrics, College of Medicine, University of Illinois Chicago, Chicago, IL, USA
| | - Jennifer Sanchez-Flack
- Department of Pediatrics, College of Medicine, University of Illinois Chicago, Chicago, IL, USA
| | - Marian Fitzgibbon
- Department of Pediatrics, College of Medicine, University of Illinois Chicago, Chicago, IL, USA
- Institute of Health Research and Policy, University of Illinois Chicago, Chicago, IL, USA
| | - Cheryl Lefaiver
- Advocate Aurora Research Institute, Advocate Aurora Health, Downers Grove, IL, USA
| | - Ashley McHugh
- Advocate Aurora Research Institute, Advocate Aurora Health, Downers Grove, IL, USA
| | - Tracy R.G. Gladstone
- Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, USA
- Wellesley Centers for Women, Wellesley College, Wellesley, MA, USA
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DiFiore G, Wood S, Jenssen BP, Fiks AG, Mayne SL. Cumulative Health Vulnerabilities Among Adolescents by Age and Neighborhood Opportunity. Pediatrics 2023; 152:e2023062657. [PMID: 37974515 PMCID: PMC10774653 DOI: 10.1542/peds.2023-062657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/07/2023] [Indexed: 11/19/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Early detection of health vulnerabilities in adolescents is integral to promoting healthy behaviors into adulthood. Our objective was to quantify the prevalence of health vulnerabilities among adolescents and examine differences by age and neighborhood opportunity. METHODS In a cross-sectional analysis of electronic health record data for adolescents aged 13 to 18 years with preventive visits in a large pediatric primary care network between September 2021 and September 2022, we examined 5 health vulnerabilities: Tobacco use, substance use, firearm access, condomless intercourse, and depressive symptoms. Health vulnerabilities were assessed via self-reported adolescent health questionnaire and the validated Patient Health Questionnaire-Modified. Prevalence of health vulnerabilities were calculated alone and in combination, and compared by age and by quintile of neighborhood Child Opportunity Index (COI) score. Multivariable logistic regression estimated associations of neighborhood COI with reporting ≥2 health vulnerabilities. RESULTS Among 40 197 adolescents (57.7% aged 13-15 years, 66.3% living in "high"/"very high" COI neighborhoods), 29.7% reported at least 1 health vulnerability and 7.9% reported ≥2 vulnerabilities. Cumulative health vulnerabilities were more prevalent among older adolescents and adolescents from lower opportunity neighborhoods. In adjusted models, lower COI was associated with 65% higher odds of having ≥2 vulnerabilities (odds ratio 1.65, 95% confidence interval 1.43-1.91) compared with adolescents from the highest COI quintile. CONCLUSIONS Understanding the relationship between health vulnerabilities and neighborhood opportunities among adolescents may allow pediatric primary care providers and health systems to offer more tailored community support services and transdiagnostic specialized care navigation to address the health needs of teens with multiple vulnerabilities.
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Affiliation(s)
| | - Sarah Wood
- Clinical Futures and PolicyLab
- The Craig Dalsimer Division of Adolescent Medicine, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
- The Department of Pediatrics, Perelman School of Medicine
- Leonard Davis Institute for Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Brian P. Jenssen
- Clinical Futures and PolicyLab
- The Department of Pediatrics, Perelman School of Medicine
- Leonard Davis Institute for Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Alexander G. Fiks
- Clinical Futures and PolicyLab
- The Craig Dalsimer Division of Adolescent Medicine, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
- The Department of Pediatrics, Perelman School of Medicine
- Leonard Davis Institute for Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Stephanie L. Mayne
- Clinical Futures and PolicyLab
- The Department of Pediatrics, Perelman School of Medicine
- Leonard Davis Institute for Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania
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Doan TT, DeJonckheere M, Wright DR, Hutton DW, Prosser LA. Preferences and experiences of pediatricians on implementing national guidelines on universal routine screening of adolescents for major depressive disorder: A qualitative study. Compr Psychiatry 2023; 127:152412. [PMID: 37717343 DOI: 10.1016/j.comppsych.2023.152412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 08/07/2023] [Accepted: 08/14/2023] [Indexed: 09/19/2023] Open
Abstract
BACKGROUND To explore the preferences of pediatricians for key factors around the implementation of universal routine screening guidelines for major depressive disorder in adolescent patients in a primary care setting. METHOD Semi-structured qualitative interviews were conducted with U.S. pediatricians. Participants were recruited by convenience sampling and snowball sampling. Qualitive data were summarized using thematic analysis to identify themes relevant to preferences around implementing screening strategies for adolescent patients. Recruitment ended upon reaching thematic saturation when no new themes were revealed. RESULTS Of the 14 participants, 11 identified as female, 3 male, 10 white, and 4 Asian. Top themes among pediatrician participants were around the screening modality (14/14 participants), screening validity (14/14), time barriers (14/14), and confidentiality barriers (12/14). Less frequently mentioned themes by pediatricians were workplace coordination and logistics (7/14), alternative starting ages for screening (7/14), more frequent screenings than annual screenings (3/14), and additional clinical training regarding depression diagnosis and treatment (2/14). LIMITATIONS Pool of interviewed participants was limited by diversity in terms of geography, race/ethnicity, or practice settings. CONCLUSIONS To promote the uptake of universal routine screening of adolescent major depression, pediatricians expressed it was important to address key implementation factors regarding the screening modality, screening validity, time constraints, and confidential care concerns in a primary care delivery context. Findings could be used to inform the development of implementation strategies to facilitate depression screening in primary care. Future research is needed to quantitively assess decisions and tradeoffs that pediatricians make when implementing universal screening to support adolescent mental health.
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Affiliation(s)
- Tran T Doan
- Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
| | - Melissa DeJonckheere
- Department of Family Medicine, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Davene R Wright
- Department of Population Medicine, Harvard Pilgrim Health Care Institute and Harvard Medical School, Boston, MA, USA
| | - David W Hutton
- Department of Health Management and Policy, University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - Lisa A Prosser
- Department of Health Management and Policy, University of Michigan School of Public Health, Ann Arbor, MI, USA; Susan B. Meister Child Health Evaluation and Research (CHEAR) Center, University of Michigan, Ann Arbor, MI, USA
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Hamdan SZ, Davis M, Faig W, Guthrie W, Yerys BE, Wallis KE. Lower Completion of Depression Screening and Higher Positivity Among Autistic Adolescents Across a Large Pediatric Primary Care Network. Acad Pediatr 2023; 23:1561-1571. [PMID: 37393034 PMCID: PMC10755081 DOI: 10.1016/j.acap.2023.06.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 06/17/2023] [Accepted: 06/23/2023] [Indexed: 07/03/2023]
Abstract
OBJECTIVE To examine rates of depression screening and positivity among autistic adolescents where electronic depression screening is administered universally; to compare rates between autistic and nonautistic youth; and to explore sociodemographic and clinical factors associated with screening completion and results. METHODS We conducted a retrospective cohort study comparing 12-17-year-old autistic and nonautistic adolescents presenting for well-child care in a large pediatric primary care network between November 2017 and January 2019 (N = 60,181). Sociodemographic and clinical data, including PHQ-9-M completion status and results, were extracted digitally from the electronic health record and compared between autistic and nonautistic youth. Logistic regression explored the relationship between sociodemographic and clinical factors and screen completion and results, stratified by autism diagnosis. RESULTS Autistic adolescents were significantly less likely to have a completed depression screen compared to nonautistic adolescents [67.0% vs 78.9%, odds ratio (OR) = 0.54, P < .01]. Among those with a completed screen, a higher percentage of autistic youths screened positive for depression (39.1% vs 22.8%; OR = 2.18, P < .01,) and suicidal ideation/behavior (13.4% vs 6.8%; OR = 2.13, P < .01). Factors associated with screening completion and positivity differed between autistic and nonautistic groups. CONCLUSIONS Autistic adolescents were less likely to have a completed depression screen when presenting for well-child care. However, when screened, they were more likely to endorse depression and suicide risk. This suggests disparities in depression screening and risk among autistic youth compared to nonautistic youth. Additional research should evaluate the source of these disparities, explore barriers to screening, and examine longitudinal outcomes of positive results among this population.
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Affiliation(s)
- Samar Z Hamdan
- Division of Developmental and Behavioral Pediatrics (SZ Hamdan, W Guthrie, and KE Wallis), Children's Hospital of Philadelphia, Philadelphia, Pa; Department of Pediatrics (SZ Hamdan, W Guthrie, and KE Wallis), Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pa.
| | - Molly Davis
- Department of Child and Adolescent Psychiatry and Behavioral Sciences (M Davis, W Guthrie, and BE Yerys), Children's Hospital of Philadelphia, Philadelphia, Pa; Penn Implementation Science Center at the Leonard Davis Institute of Health Economics (PISCE@LDI) (M Davis), University of Pennsylvania, Philadelphia, Pa; Department of Psychiatry (M Davis, W Guthrie, and BE Yerys), Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pa.
| | - Walter Faig
- Biostatistics and Data Management Core (W Faig), Children's Hospital of Philadelphia, Philadelphia, Pa.
| | - Whitney Guthrie
- Division of Developmental and Behavioral Pediatrics (SZ Hamdan, W Guthrie, and KE Wallis), Children's Hospital of Philadelphia, Philadelphia, Pa; Department of Pediatrics (SZ Hamdan, W Guthrie, and KE Wallis), Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pa; Department of Child and Adolescent Psychiatry and Behavioral Sciences (M Davis, W Guthrie, and BE Yerys), Children's Hospital of Philadelphia, Philadelphia, Pa; Department of Psychiatry (M Davis, W Guthrie, and BE Yerys), Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pa; Center for Autism Research (W Guthrie, BE Yerys, and KE Wallis), Children's Hospital of Philadelphia, Philadelphia, Pa; Clinical Futures (W Guthrie, BE Yerys, and KE Wallis), Children's Hospital of Philadelphia, Philadelphia, Pa. Dr Hamdan is now with the Department of Pediatrics, King Abdulaziz University Hospital, Jeddah, Saudi Arabia.
| | - Benjamin E Yerys
- Department of Child and Adolescent Psychiatry and Behavioral Sciences (M Davis, W Guthrie, and BE Yerys), Children's Hospital of Philadelphia, Philadelphia, Pa; Department of Psychiatry (M Davis, W Guthrie, and BE Yerys), Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pa; Center for Autism Research (W Guthrie, BE Yerys, and KE Wallis), Children's Hospital of Philadelphia, Philadelphia, Pa; Clinical Futures (W Guthrie, BE Yerys, and KE Wallis), Children's Hospital of Philadelphia, Philadelphia, Pa. Dr Hamdan is now with the Department of Pediatrics, King Abdulaziz University Hospital, Jeddah, Saudi Arabia.
| | - Kate E Wallis
- Division of Developmental and Behavioral Pediatrics (SZ Hamdan, W Guthrie, and KE Wallis), Children's Hospital of Philadelphia, Philadelphia, Pa; Department of Pediatrics (SZ Hamdan, W Guthrie, and KE Wallis), Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pa; Center for Autism Research (W Guthrie, BE Yerys, and KE Wallis), Children's Hospital of Philadelphia, Philadelphia, Pa; Clinical Futures (W Guthrie, BE Yerys, and KE Wallis), Children's Hospital of Philadelphia, Philadelphia, Pa. Dr Hamdan is now with the Department of Pediatrics, King Abdulaziz University Hospital, Jeddah, Saudi Arabia.
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11
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Hannan C, Mayne SL, Kelly MK, Davis M, Young JF, Powell M, Stephens-Shields A, Dalembert G, McPeak KE, Jenssen BP, Fiks AG. Trends in Positive Depression and Suicide Risk Screens in Pediatric Primary Care During COVID-19. Acad Pediatr 2023; 23:1159-1165. [PMID: 36584938 PMCID: PMC9792424 DOI: 10.1016/j.acap.2022.12.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Revised: 12/08/2022] [Accepted: 12/17/2022] [Indexed: 12/28/2022]
Abstract
OBJECTIVE Adolescent mental health concerns increased during COVID-19, but it is unknown whether early increases in depression and suicide risk have been sustained. We examined changes in positive screens for depression and suicide risk in a large pediatric primary care network through May 2022. METHODS Using an observational repeated cross-sectional design, we examined changes in depression and suicide risk during the pandemic using electronic health record data from adolescents. Segmented logistic regression was used to estimate risk differences (RD) for positive depression and suicide risk screens during the early pandemic (June 2020-May 2021) and late pandemic (June 2021-May 2022) relative to before the pandemic (March 2018-February 2020). Models adjusted for seasonality and standard errors accounted for clustering by practice. RESULTS Among 222,668 visits for 115,627 adolescents (mean age 15.7, 50% female), the risk of positive depression and suicide risk screens increased during the early pandemic period relative to the prepandemic period (RD, 3.8%; 95% CI, 2.9, 4.8; RD, 2.8%; 95% CI, 1.7, 3.8). Risk of depression returned to baseline during the late pandemic period, while suicide risk remained slightly elevated (RD, 0.7%; 95% CI, -0.4, 1.7; RD, 1.8%; 95% CI, 0.9%, 2.7%). CONCLUSIONS During the early months of the pandemic, there was an increase in positive depression and suicide risk screens, which later returned to prepandemic levels for depression but not suicide risk. Results suggest that pediatricians should continue to prioritize screening adolescents for depressive symptoms and suicide risk and connect them to treatment.
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Affiliation(s)
- Chloe Hannan
- Clincial Futures (A Research Institute Center of Emphasis) and The Possibilities Project, Children's Hospital of Philadelphia (C Hannan, SL Mayne, MK Kelly, M Powell, G Dalembert, KE McPeak, BP Jenssen, and AG Fiks), Philadelphia, Pa
| | - Stephanie L Mayne
- Clincial Futures (A Research Institute Center of Emphasis) and The Possibilities Project, Children's Hospital of Philadelphia (C Hannan, SL Mayne, MK Kelly, M Powell, G Dalembert, KE McPeak, BP Jenssen, and AG Fiks), Philadelphia, Pa; Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania (SL Mayne, G Dalembert, KE McPeak, BP Jenssen, and AG Fiks), Philadelphia, Pa.
| | - Mary Kate Kelly
- Clincial Futures (A Research Institute Center of Emphasis) and The Possibilities Project, Children's Hospital of Philadelphia (C Hannan, SL Mayne, MK Kelly, M Powell, G Dalembert, KE McPeak, BP Jenssen, and AG Fiks), Philadelphia, Pa
| | - Molly Davis
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, and PolicyLab, Children's Hospital of Philadelphia (M Davis and JF Young), Philadelphia, Pa; Penn Implementation Science Center at the Leonard Davis Institute of Health Economics (PISCE@LDI), University of Pennsylvania (M Davis and AG Fiks), Philadelphia, Pa
| | - Jami F Young
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, and PolicyLab, Children's Hospital of Philadelphia (M Davis and JF Young), Philadelphia, Pa; Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania (JF Young), Philadelphia, Pa
| | - Maura Powell
- Clincial Futures (A Research Institute Center of Emphasis) and The Possibilities Project, Children's Hospital of Philadelphia (C Hannan, SL Mayne, MK Kelly, M Powell, G Dalembert, KE McPeak, BP Jenssen, and AG Fiks), Philadelphia, Pa
| | - Alisa Stephens-Shields
- Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania (A Stephens-Shields), Philadelphia, Pa
| | - George Dalembert
- Clincial Futures (A Research Institute Center of Emphasis) and The Possibilities Project, Children's Hospital of Philadelphia (C Hannan, SL Mayne, MK Kelly, M Powell, G Dalembert, KE McPeak, BP Jenssen, and AG Fiks), Philadelphia, Pa; Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania (SL Mayne, G Dalembert, KE McPeak, BP Jenssen, and AG Fiks), Philadelphia, Pa
| | - Katie E McPeak
- Clincial Futures (A Research Institute Center of Emphasis) and The Possibilities Project, Children's Hospital of Philadelphia (C Hannan, SL Mayne, MK Kelly, M Powell, G Dalembert, KE McPeak, BP Jenssen, and AG Fiks), Philadelphia, Pa; Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania (SL Mayne, G Dalembert, KE McPeak, BP Jenssen, and AG Fiks), Philadelphia, Pa
| | - Brian P Jenssen
- Clincial Futures (A Research Institute Center of Emphasis) and The Possibilities Project, Children's Hospital of Philadelphia (C Hannan, SL Mayne, MK Kelly, M Powell, G Dalembert, KE McPeak, BP Jenssen, and AG Fiks), Philadelphia, Pa; Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania (SL Mayne, G Dalembert, KE McPeak, BP Jenssen, and AG Fiks), Philadelphia, Pa
| | - Alexander G Fiks
- Clincial Futures (A Research Institute Center of Emphasis) and The Possibilities Project, Children's Hospital of Philadelphia (C Hannan, SL Mayne, MK Kelly, M Powell, G Dalembert, KE McPeak, BP Jenssen, and AG Fiks), Philadelphia, Pa; Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania (SL Mayne, G Dalembert, KE McPeak, BP Jenssen, and AG Fiks), Philadelphia, Pa; Penn Implementation Science Center at the Leonard Davis Institute of Health Economics (PISCE@LDI), University of Pennsylvania (M Davis and AG Fiks), Philadelphia, Pa
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12
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Karcher NR, Hicks R, Schiffman J, Asarnow JR, Calkins ME, Dauberman JL, Garrett CD, Koli RL, Larrauri CA, Loewy RL, McGough CA, Murphy JM, Niendam TA, Roaten K, Rodriguez J, Staglin BK, Wissow L, Woodberry KA, Young JF, Gur RE, Bearden CE, Barch DM. Youth Mental Health Screening and Linkage to Care. Psychiatr Serv 2023; 74:727-736. [PMID: 36695011 PMCID: PMC10329990 DOI: 10.1176/appi.ps.202200008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
One Mind, in partnership with Meadows Mental Health Policy Institute, convened several virtual meetings of mental health researchers, clinicians, and other stakeholders in 2020 to identify first steps toward creating an initiative for early screening and linkage to care for youths (individuals in early adolescence through early adulthood, ages 10-24 years) with mental health difficulties, including serious mental illness, in the United States. This article synthesizes and builds on discussions from those meetings by outlining and recommending potential steps and considerations for the development and integration of a novel measurement-based screening process in youth-facing school and medical settings to increase early identification of mental health needs and linkage to evidence-based care. Meeting attendees agreed on an initiative incorporating a staged assessment process that includes a first-stage brief screener for several domains of psychopathology. Individuals who meet threshold criteria on the first-stage screener would then complete an interview, a second-stage in-depth screening, or both. Screening must be followed by recommendations and linkage to an appropriate level of evidence-based care based on acuity of symptoms endorsed during the staged assessment. Meeting attendees proposed steps and discussed additional considerations for creating the first nationwide initiative for screening and linkage to care, an initiative that could transform access of youths to mental health screening and care.
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Affiliation(s)
- Nicole R. Karcher
- Department of Psychiatry, Washington University in St. Louis, School of Medicine, St. Louis, MO
| | | | - Jason Schiffman
- Department of Psychological Science, University of California, Irvine, CA
| | - Joan R. Asarnow
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, UCLA, Los Angeles, CA
| | - Monica E. Calkins
- Department of Psychiatry, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA
| | - Judith L. Dauberman
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA
| | - Chantel D. Garrett
- Department of Health Services, Strong 365, University of Washington, Seattle, WA
| | - Roshni L. Koli
- Department of Psychiatry, University of Texas at Austin, Dell Medical School, Austin, TX, USA
| | | | - Rachel L. Loewy
- Department of Psychiatry, University of California, San Francisco, CA
| | | | - J. Michael Murphy
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Tara A. Niendam
- Department of Psychiatry and Behavioral Sciences, University of California, Davis, Sacramento, CA
| | - Kimberly Roaten
- Department of Psychiatry, Meadows Mental Health Policy Institute, University of Texas Southwestern Medical Center, Dallas, TX
| | - Jacqueline Rodriguez
- Student Support & Health Services, Sacramento City Unified School District, Sacramento, CA
| | | | - Lawrence Wissow
- Department of Psychiatry, University of Washington, Seattle, WA
| | - Kristen A. Woodberry
- Center for Psychiatric Research, Maine Medical Center Research Institute, Scarborough, ME
- Department of Psychiatry, Tufts School of Medicine, Boston, MA
| | - Jami F. Young
- Department of Psychiatry, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children’s Hospital of Philadelphia, PA
| | - Raquel E. Gur
- Department of Psychiatry, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children’s Hospital of Philadelphia, PA
| | - Carrie E. Bearden
- Department of Psychiatry and Biobehavioral Sciences and Psychology, Semel Institute for Neuroscience and Human Behavior, UCLA, Los Angeles, CA
| | - Deanna M. Barch
- Department of Psychiatry, Washington University in St. Louis, School of Medicine, St. Louis, MO
- Departments of Psychological & Brain Sciences and Radiology, Washington University in St. Louis, St. Louis, MO
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13
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Kanine RM, Bush ML, Davis M, Jones JD, Sbrilli MD, Young JF. Depression Prevention in Pediatric Primary Care: Implementation and Outcomes of Interpersonal Psychotherapy-Adolescent Skills Training. Child Psychiatry Hum Dev 2023; 54:96-108. [PMID: 34379228 DOI: 10.1007/s10578-021-01222-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/25/2021] [Indexed: 01/27/2023]
Abstract
This study evaluated the fidelity, feasibility, acceptability, and preliminary outcomes of a depression prevention program, interpersonal psychotherapy-adolescent skills training (IPT-AST), in urban pediatric primary care (PC) with a sample of primarily Black youth. Twenty-two adolescents with elevated depressive symptoms participated in this open clinical trial. Adolescents were identified through a screening questionnaire completed at well visits. Ratings of IPT-AST fidelity and session attendance were recorded. Youth and caregivers reported on their attitudes toward the intervention and completed measures of adolescents' symptoms and functioning pre- and post-intervention. Results demonstrated high levels of fidelity, attendance, and acceptability, despite some difficulties with recruitment. Adolescents and caregivers reported significant improvements in functioning. There were marginally significant reductions in self-reported depression, anxiety, and total mental health symptoms. Caregivers reported a significant decrease in total mental health symptoms. Findings provide preliminary information regarding the implementation and effects of IPT-AST when delivered in PC.
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Affiliation(s)
- Rebecca M Kanine
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, 2716 South St., Room 8472, Philadelphia, PA, 19146, USA.
| | - Morgan L Bush
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, 2716 South St., Room 8472, Philadelphia, PA, 19146, USA
| | - Molly Davis
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.,Penn Implementation Science Center at the Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA
| | - Jason D Jones
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, 2716 South St., Room 8472, Philadelphia, PA, 19146, USA.,Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Marissa D Sbrilli
- Clinical-Community Psychology PhD Program, Department of Psychology, University of Illinois - Urbana Champaign, Champaign, IL, USA
| | - Jami F Young
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, 2716 South St., Room 8472, Philadelphia, PA, 19146, USA.,Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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14
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Riehm KE, Brignone E, Gallo JJ, Stuart EA, Mojtabai R. Emergency health services use and medically-treated suicidal behaviors following depression screening among adolescents: A longitudinal cohort study. Prev Med 2022; 161:107148. [PMID: 35803349 DOI: 10.1016/j.ypmed.2022.107148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 05/24/2022] [Accepted: 07/03/2022] [Indexed: 11/28/2022]
Abstract
The primary goal of depression screening is to reduce adverse psychiatric outcomes, which may have downstream implications for reducing avoidable health services use. The objective of this study was to examine the association of depression screening with emergency health services use and medically-treated suicidal behaviors among adolescents in the U.S. This longitudinal cohort study used insurance claims data from 57,732 adolescents who had at least one well-visit between 2014 and 2017. Propensity score matching was used to compare adolescents who were screened for depression to similar adolescents who were not screened for depression during the well-visit. Outcomes were examined over two-year follow-up and included emergency department use and inpatient hospitalizations for depression-related reasons, mental health-related reasons, and any reason as well as medically-treated suicidal behaviors. Log-binomial regression models were used to examine associations between depression screening and each outcome in the matched sample. Heterogeneity of associations by sex was examined with interaction terms. Being screened for depression was not consistently associated with emergency department use (depression-related reasons: RR = 1.00, 95% CI = 0.76-1.30; mental health-related reasons: RR = 1.02, 95% CI = 0.80-1.29; any reason: RR = 0.96, 95% CI = 0.83-1.11), inpatient hospitalizations (depression-related reasons: RR = 1.05, 95% CI = 0.84-1.31; mental health-related reasons: RR = 1.16, 95% CI = 1.00-1.33; any reason: RR = 1.05, 95% CI = 0.99-1.12), or medically-treated suicidal behaviors (RR = 0.83, 95% CI = 0.51-1.36). Associations were similar in magnitude among male and female adolescents. The results of this study suggest that depression screening, as it is currently practiced in the U.S., may not deter avoidable health services use among adolescents.
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Affiliation(s)
- Kira E Riehm
- Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA.
| | - Emily Brignone
- Data Science Research and Development, Highmark Health, Pittsburgh, PA, USA
| | - Joseph J Gallo
- Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA; Department of Psychiatry & Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Elizabeth A Stuart
- Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Ramin Mojtabai
- Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
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15
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Integrating Behavioral Health in Primary Care: Lessons from Interdisciplinary Collaboration in School Mental Health. Pediatr Clin North Am 2022; 69:709-723. [PMID: 35934495 DOI: 10.1016/j.pcl.2022.04.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Integrating behavioral health care into pediatric primary care (PPC) settings can increase access to behavioral health promotion services and treatment. Efficient models for integrated PPC are emerging. Recent reviews call for integrated PPC research to better identify efficient teaming and processes, particularly in areas of building integrated PPC team member capacity and adopting practices that promote "upstream" behavioral wellness specific to community needs. Research in integrating behavioral health in schools has identified key practices relevant to these gaps in integrated primary care (IPC) research. This article discusses possibilities to apply findings from integrated school behavioral health research to IPC settings.
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Davis M, Hoskins K, Phan M, Hoffacker C, Reilly M, Fugo PB, Young JF, Beidas RS. Screening Adolescents for Sensitive Health Topics in Primary Care: A Scoping Review. J Adolesc Health 2022; 70:706-713. [PMID: 34955356 PMCID: PMC9038619 DOI: 10.1016/j.jadohealth.2021.10.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 10/18/2021] [Accepted: 10/21/2021] [Indexed: 11/15/2022]
Abstract
We sought to aggregate common barriers and facilitators to screening adolescents for sensitive health topics (e.g., depression, chlamydia) in primary care, as well as those that are unique to a given health topic. We conducted a literature search of three databases (PsycInfo, MEDLINE, and CINAHL) and reference lists of included articles. Studies focused on barriers and facilitators to screening adolescents (ages 12-17 years) for sensitive health topics in primary care that are recommended by national guidelines. Articles were peer-reviewed, presented empirical data, and were published in English in 2006-2021. We coded barriers and facilitators using the Consolidated Framework for Implementation Research, a well-established framework within implementation science. In total, 39 studies met inclusion criteria and spanned several health topics: depression, suicide, substance use, HIV, and chlamydia. We found common barriers and facilitators to screening across health topics, with most relating to characteristics of the primary care clinics (e.g., time constraints). Other factors relevant to screening implementation ranged from confidentiality concerns to clinician knowledge. Barriers and facilitators specific to certain health topics, such as the availability of on-site laboratories for HIV screening, were also noted. Findings can guide refinements to screening implementation.
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Affiliation(s)
- Molly Davis
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania; Penn Implementation Science Center at the Leonard Davis Institute of Health Economics (PISCE@LDI), University of Pennsylvania, Philadelphia, Pennsylvania.
| | - Katelin Hoskins
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA;,Penn Implementation Science Center at the Leonard Davis Institute of Health Economics (PISCE@LDI), University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Mary Phan
- Emma Eccles Jones College of Education and Human Services, Utah State University, Logan, Utah, USA
| | - Carlin Hoffacker
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Megan Reilly
- Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Perrin B. Fugo
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Jami F. Young
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA;,Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children’s Hospital of Philadelphia, USA and PolicyLab, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Rinad S. Beidas
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA;,Penn Implementation Science Center at the Leonard Davis Institute of Health Economics (PISCE@LDI), University of Pennsylvania, Philadelphia, Pennsylvania, USA;,Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA;,Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA;,Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania, USA;,Center for Health Incentives and Behavioral Economics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA;,Penn Medicine Nudge Unit, University of Pennsylvania Health System, Philadelphia, Pennsylvania, USA
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17
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Improving Primary Care Adolescent Depression Screening and Initial Management: A Quality Improvement Study. Pediatr Qual Saf 2022; 7:e549. [PMID: 35369419 PMCID: PMC8970087 DOI: 10.1097/pq9.0000000000000549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 01/26/2022] [Indexed: 11/26/2022] Open
Abstract
Although recommended, adolescent depression screening with appropriate initial management is challenging. This project aimed to improve adolescent depression screening rates during preventive care visits in 12 primary care clinics from 65.4% to 80%, increase the proportion of documented initial management for those with a positive screen from 69.5% to 85%, then sustain improvements for 12 months.
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18
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Adolescent depression screening in primary care: Who is screened and who is at risk? J Affect Disord 2022; 299:318-325. [PMID: 34910961 DOI: 10.1016/j.jad.2021.12.022] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 12/03/2021] [Accepted: 12/10/2021] [Indexed: 11/20/2022]
Abstract
BACKGROUND Limited research has simultaneously focused on sociodemographic differences in who receives recommended adolescent depression screening in primary care and who endorses elevated depression and suicide risk on these screeners. We describe screening and risk rates in a large pediatric primary care network in the United States after the network expanded its universal depression screening guideline to cover all well-visits (i.e., annual medical checkups) for adolescents ages 12 and older. METHODS Between November 15, 2017 and February 1, 2020, there were 122,682 well-visits for adolescents ages 12-17 (82,531 unique patients). The Patient Health Questionnaire - Modified for Teens (PHQ-9-M) was administered to screen for depression. RESULTS A total of 99,961 PHQ-9-Ms were administered (screening rate=81.48%). The likelihood of screening was higher among adolescents who were female, 12-14 years of age at their first well-visit during the study, White, Hispanic/Latino, or publicly-insured (i.e., Medicaid-insured). Additionally, 5.92% of adolescents scored in the threshold range for depression symptoms and 7.19% endorsed suicidality. Heightened depression and suicide risk were observed among adolescents who were female, 15-17 years of age at their first well-visit during the study, Black, Hispanic/Latino, attending urban primary care practices, or Medicaid-insured. Odds of endorsing suicidality were also higher among teens who identified as other races. LIMITATIONS Limitations related to data available in the electronic health record and reliance on data from a single hospital system are noted. CONCLUSIONS Findings highlight misalignments in screening and risk status that are important to address to ensure more equitable screening implementation and health outcomes.
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Sarakbi D, Groll D, Tranmer J, Sears K. Achieving Quality Integrated Care for Adolescent Depression: A Scoping Review. J Prim Care Community Health 2022; 13:21501319221131684. [PMID: 36345229 PMCID: PMC9647275 DOI: 10.1177/21501319221131684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Introduction: While primary care is often the first point of contact for adolescents with
depression, more than half of depressed adolescents are either untreated or
undertreated. A scoping review had been completed to summarize approaches
for achieving quality integrated care in primary care focused on adolescent
depression. Methods: The scoping review followed the methodological framework for scoping studies
from Arksey and O’Malley. Articles were grouped into themes and mapped to 6
quality domains for integrated care from the practice integration profile
survey and 3 levels of stakeholders based on WHO’s definition for health
systems (patient/family, primary care team, and national/sub-national health
system). Results: A total of 868 records were screened resulting in 22 articles at the
patient/family-level (5/22), the primary care team-level (18/22), and the
national/sub-national health system-level (16/22). The results highlighted
multilevel approaches to support the delivery of quality integrated care for
adolescent depression in primary care: (1) population-focused using patient
registries, routine screening based on standardized algorithms, and
patient-centered strategies, (2) team-driven where primary care clinicians
collaborate with mental health clinicians as part of a primary care team,
(3) evidence-based delivery of mental health services across the integrated
care pathway from screening to follow-up visits, and (4) measurement-guided
by leveraging the electronic health record infrastructure to learn from
patient outcomes. Conclusion: More research is needed on how to provide quality integrated care for
adolescent depression, specifically on patient engagement and retention,
grounded in the frontline experiences of patients, families, and clinicians
and supported by national and/or sub-national guidelines. A learning system
could help integrate mental health services in primary care in a way that is
consistent across the national and/or sub-national health system.
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Affiliation(s)
| | | | | | - Kim Sears
- Queen’s University, Kingston, ON, Canada
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20
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Valicenti-McDermott M, Rivelis E, Bernstein C, Cardin MJ, Seijo R. Screening for Depression in Adolescents with Developmental Disabilities: Brief Report. J Child Adolesc Psychopharmacol 2021; 31:572-576. [PMID: 34582695 DOI: 10.1089/cap.2021.0062] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Objectives: (1) To examine adherence of universal screening for adolescent depression at initial visits by using an established screening instrument (Patient Health Questionnaire 9 [PHQ-9]) in a university-affiliated urban developmental center that serves children with developmental disabilities (DDs); (2) to study the frequency of positive screening for depression in adolescents with DD. Methods: Review of all adolescents referred for multidisciplinary evaluation in a developmental center in 2019. Data included demographics, DD diagnoses, and use of and scores on the PHQ-9 at initial visit. Statistics included chi-square and non-parametrics. Results: Of all the children evaluated in 2019 (n = 240), 52 were adolescents, 35 boys (63%)/17 girls (37%), age 14 ± 2 years old, and 27 (54%) belonging to a bilingual English-Spanish household. DD: Developmental Language Disorder (88%), Learning Disabilities (54%), attention-deficit/hyperactivity disorder (44%), Autism Spectrum Disorder (25%), Intellectual Disabilities (12%), and Phonological Disorder (8%). The PHQ-9 was administered to 30 (58%) individuals. Scores varied from minimal depression for 17 (57%), mild for 10 (33%), and moderate and severe for 3 (10%); 3 patients endorsed suicidality. Females were more likely to obtain higher scores on the PHQ-9 than males. Adolescents diagnosed with Autism Spectrum Disorder, Intellectual Disabilities, and Phonological Disorder were less likely to be screened. Conclusion: More than half of the sample of urban adolescents with DD were screened for depression at initial visit, and 10% screened positive for moderate to severe depression. Efforts to follow the U.S. Preventive Services Task Force recommendation of universal screening of adolescent depression should continue. However, given challenges with reading and verbal abilities, screening modifications (reading to them) should be considered.
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Affiliation(s)
- Maria Valicenti-McDermott
- RFK Children's Evaluation and Rehabilitation Center, Children's Hospital at Montefiore, Bronx, New York, USA
| | - Erin Rivelis
- RFK Children's Evaluation and Rehabilitation Center, Children's Hospital at Montefiore, Bronx, New York, USA
| | - Carla Bernstein
- RFK Children's Evaluation and Rehabilitation Center, Children's Hospital at Montefiore, Bronx, New York, USA
| | - Marie Joanne Cardin
- RFK Children's Evaluation and Rehabilitation Center, Children's Hospital at Montefiore, Bronx, New York, USA
| | - Rosa Seijo
- RFK Children's Evaluation and Rehabilitation Center, Children's Hospital at Montefiore, Bronx, New York, USA
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21
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Mayne SL, Hannan C, Davis M, Young JF, Kelly MK, Powell M, Dalembert G, McPeak KE, Jenssen BP, Fiks AG. COVID-19 and Adolescent Depression and Suicide Risk Screening Outcomes. Pediatrics 2021; 148:peds.2021-051507. [PMID: 34140393 DOI: 10.1542/peds.2021-051507] [Citation(s) in RCA: 108] [Impact Index Per Article: 36.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/07/2021] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Mental health concerns increased during the coronavirus disease 2019 pandemic, but previous studies have not examined depression screening in pediatric primary care. We aimed to describe changes in screening, depressive symptoms, and suicide risk among adolescents during the coronavirus disease 2019 pandemic. METHODS In a repeat cross-sectional analysis of electronic health record data from a large pediatric primary care network, we compared the percentage of primary care visits where adolescents aged 12 to 21 were screened for depression, screened positive for depressive symptoms, or screened positive for suicide risk between June and December 2019 (prepandemic) and June and December 2020 (pandemic). Changes were examined overall, by month, and by sex, race and ethnicity, insurance type, and income. Modified Poisson regression was used to calculate prevalence ratios (PRs) for the prepandemic to pandemic changes. RESULTS Depression screening at primary care visits declined from 77.6% to 75.8% during the pandemic period (PR: 0.98, 95% confidence interval [CI]: 0.90-1.06). The percentage of adolescents screening positive for depressive symptoms increased from 5.0% to 6.2% (PR: 1.24, 95% CI: 1.15-1.34), with greater increases among female, non-Hispanic Black, and non-Hispanic white adolescents. Positive suicide risk screens increased from 6.1% to 7.1% (PR: 1.16, 95% CI: 1.08-1.26), with a 34% relative increase in reporting recent suicidal thoughts among female adolescents (PR: 1.34, 95% CI: 1.18-1.52). CONCLUSIONS Results suggest that depression and suicide concerns have increased during the pandemic, especially among female adolescents. Results underscore the importance of consistent depression and suicidality screening.
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Affiliation(s)
- Stephanie L Mayne
- The Possibilities Project, Children's Hospital of Philadelphia .,Departments of Pediatrics.,Center for Pediatric Clinical Effectiveness and PolicyLab
| | - Chloe Hannan
- The Possibilities Project, Children's Hospital of Philadelphia.,Center for Pediatric Clinical Effectiveness and PolicyLab
| | - Molly Davis
- Psychiatry, Perelman School of Medicine.,Penn Implementation Science Center at the Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Jami F Young
- Center for Pediatric Clinical Effectiveness and PolicyLab.,Psychiatry, Perelman School of Medicine.,Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Mary Kate Kelly
- The Possibilities Project, Children's Hospital of Philadelphia.,Center for Pediatric Clinical Effectiveness and PolicyLab
| | - Maura Powell
- The Possibilities Project, Children's Hospital of Philadelphia
| | - George Dalembert
- The Possibilities Project, Children's Hospital of Philadelphia.,Departments of Pediatrics.,Center for Pediatric Clinical Effectiveness and PolicyLab
| | - Katie E McPeak
- The Possibilities Project, Children's Hospital of Philadelphia.,Departments of Pediatrics.,Center for Pediatric Clinical Effectiveness and PolicyLab
| | - Brian P Jenssen
- The Possibilities Project, Children's Hospital of Philadelphia.,Departments of Pediatrics.,Center for Pediatric Clinical Effectiveness and PolicyLab
| | - Alexander G Fiks
- The Possibilities Project, Children's Hospital of Philadelphia.,Departments of Pediatrics.,Center for Pediatric Clinical Effectiveness and PolicyLab
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22
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Kemper AR, Hostutler CA, Beck K, Fontanella CA, Bridge JA. Depression and Suicide-Risk Screening Results in Pediatric Primary Care. Pediatrics 2021; 148:peds.2021-049999. [PMID: 34099503 DOI: 10.1542/peds.2021-049999] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/01/2021] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES 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. METHODS 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). RESULTS 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 (n = 205), 35.6% screened positive for MDD (n = 90), and 42.7% with a positive ASQ result (n = 75) had a depression or self-harm diagnosis or an antidepressant prescription. CONCLUSIONS 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.
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Affiliation(s)
- Alex R Kemper
- Division of Primary Care Pediatrics .,Department of Pediatrics, College of Medicine
| | - Cody A Hostutler
- Department of Pediatrics, College of Medicine.,Department of Pediatric Psychology and Neuropsychology, Nationwide Children's Hospital, Columbus, Ohio
| | - Kristen Beck
- Division of Primary Care Pediatrics.,Department of Pediatrics, College of Medicine
| | - Cynthia A Fontanella
- Department of Psychiatry and Behavioral Health, Wexner Medical Center, The Ohio State University, Columbus, Ohio
| | - Jeffrey A Bridge
- Department of Pediatrics, College of Medicine.,Department of Psychiatry and Behavioral Health, Wexner Medical Center, The Ohio State University, Columbus, Ohio.,Center for Suicide Prevention and Research, Abigail Wexner Research Institute
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23
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Few primary care pediatricians screen for psychosis but many are willing. Schizophr Res 2021; 232:65-67. [PMID: 34022617 DOI: 10.1016/j.schres.2021.05.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 04/27/2021] [Accepted: 05/02/2021] [Indexed: 11/21/2022]
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24
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Jellinek M, Bergmann P, Holcomb JM, Riobueno-Naylor A, Dutta A, Haile H, Sturner R, Howard B, Murphy JM. Recognizing Adolescent Depression with Parent- and Youth-Report Screens in Pediatric Primary Care. J Pediatr 2021; 233:220-226.e1. [PMID: 33548264 DOI: 10.1016/j.jpeds.2021.01.069] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 01/12/2021] [Accepted: 01/28/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To compare the use of the parent-report Pediatric Symptom Checklist (PSC-17P) and youth-report Patient Health Questionnaire-9 Modified for Teens (PHQ-9M) in compliance with recent quality standards for adolescent depression screening. STUDY DESIGN Parents of 5411 pediatric outpatients (11.0-17.9 years old) completed the PSC-17P, which contains scales that assign categorical risk for overall (PSC-17P-OVR), internalizing (PSC-17P-INT), externalizing (PSC-17P-EXT), and attention (PSC-17P-ATT) problems. Adolescents completed the PHQ-9M, which assesses depressive symptoms. Both forms were completed online within 24 hours of each other before pediatric well-child visits. RESULTS A total of 9.9% of patients (n = 535) were at risk on the PSC-17P-OVR, 14.3% (n = 775) were at risk on the PSC-17P-INT, and 17.0% (n = 992) were at risk on either or both scales (PSC-17P-OVR and/or PSC-17P-INT). Using the PHQ-9M cut-off score of 10 (moderate-very severe depression), an additional 2.4% (n = 131) were classified as at risk, with 66.8% (n = 263) of all PHQ-9M positives (n = 394) also coded as at risk by the PSC-17P-OVR and/or PSC-17P-INT scales. Using a PHQ-9M cut-off score of 15 (severe-very severe depression), only 29 patients (21.8% of the PHQ-9M positives) not identified by the PSC-17P-OVR and/or PSC-17P-INT were classified as being at risk. CONCLUSIONS The combined PSC-17P-OVR and/or PSC-17P-INT scales identified 17% of adolescents as at risk for depression, including about two-thirds to three-quarters of adolescents classified as at risk on the PHQ-9M. These findings support using the PSC-17P to meet quality standards for depression as well as overall screening in pediatrics. Primary care clinicians can add the PHQ-9M to identify additional adolescents who may self-report depressive symptoms.
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Affiliation(s)
- Michael Jellinek
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA; Department of Psychiatry, Harvard Medical School, Boston, MA; Department of Pediatrics, Harvard Medical School, Boston, MA
| | | | - Juliana M Holcomb
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA
| | - Alexa Riobueno-Naylor
- Department of Counseling, Developmental, and Educational Psychology, Lynch School of Education and Human Development, Boston College, Boston, MA
| | - Anamika Dutta
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA
| | - Haregnesh Haile
- Department of Psychology, The Catholic University of America, Washington, DC
| | - Raymond Sturner
- Department of Pediatrics, The John Hopkins University School of Medicine, Baltimore, MD; Center for Promotion of Child Development through Primary Care, Baltimore, MD
| | - Barbara Howard
- Department of Pediatrics, The John Hopkins University School of Medicine, Baltimore, MD; Total Child Health, Baltimore, MD
| | - J Michael Murphy
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA; Department of Psychiatry, Harvard Medical School, Boston, MA.
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25
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Mautone JA, Wolk CB, Cidav Z, Davis MF, Young JF. Strategic Implementation Planning for Integrated Behavioral Health Services in Pediatric Primary Care. IMPLEMENTATION RESEARCH AND PRACTICE 2021; 2. [PMID: 34337415 PMCID: PMC8320620 DOI: 10.1177/2633489520987558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background Delivering physical and behavioral health services in a single setting is associated with improved quality of care and reduced health care costs. Few health systems implementing integrated care develop conceptual models and targeted measurement strategies a priori with an eye toward adoption, implementation, sustainment, and evaluation. This is a broad challenge in the field, which can make it difficult to disentangle why implementation is or is not successful. Method This paper discusses strategic implementation and evaluation planning for a pediatric integrated care program in a large health system. Our team developed a logic model, which defines resources and community characteristics, program components, evaluation activities, short-term activities, and intermediate and anticipated long-term patient-, clinician-, and practice-related outcomes. The model was designed based on research and stakeholder input to support strategic implementation and evaluation of the program. For each aspect of the logic model, a measurement battery was selected. Initial implementation data and intermediate outcomes from a pilot in five practices in a 30-practice pediatric primary care network are presented to illustrate how the logic model and evaluation plan have been used to guide the iterative process of program development. Results A total of 4,619 office visits were completed during the two years of the pilot. Primary care clinicians were highly satisfied with the integrated primary care program and provided feedback on ways to further improve the program. Members of the primary care team and behavioral health providers rated the program as being relatively well integrated into the practices after the second year of the pilot. Conclusions This logic model and evaluation plan provide a template for future projects integrating behavioral health services in non-specialty mental health settings, including pediatric primary care, and can be used broadly to provide structure to implementation and evaluation activities and promote replication of effective initiatives.
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Affiliation(s)
- Jennifer A Mautone
- Department of Child & Adolescent Psychiatry & Behavioral Sciences, Children's Hospital of Philadelphia.,Department of Psychiatry, Perelman School of Medicine at University of Pennsylvania
| | - Courtney Benjamin Wolk
- Department of Psychiatry, Perelman School of Medicine at University of Pennsylvania.,Leonard Davis Institute for Health Economics at University of Pennsylvania
| | - Zuleyha Cidav
- Department of Psychiatry, Perelman School of Medicine at University of Pennsylvania
| | - Molly F Davis
- Department of Psychiatry, Perelman School of Medicine at University of Pennsylvania.,Penn Implementation Science Center at the Leonard Davis Institute of Health Economics (PISCE@LDI)
| | - Jami F Young
- Department of Child & Adolescent Psychiatry & Behavioral Sciences, Children's Hospital of Philadelphia.,Department of Psychiatry, Perelman School of Medicine at University of Pennsylvania
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26
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Davis M, Rio V, Farley AM, Bush ML, Beidas RS, Young JF. Identifying Adolescent Suicide Risk via Depression Screening in Pediatric Primary Care: An Electronic Health Record Review. Psychiatr Serv 2021; 72:163-168. [PMID: 33334159 PMCID: PMC7890460 DOI: 10.1176/appi.ps.202000207] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The authors evaluated suicide risk rates detected via a depression screener administered within a large pediatric primary care system and examined 1-year follow-up care after adolescents' endorsement of suicide risk. METHODS Retrospective electronic health record data were extracted to examine both suicide risk rates from items endorsed on the Patient Health Questionnaire-Modified for Teens (PHQ-9-M) and primary care providers' (PCPs') follow-up suicide risk assessments on the day of depression screening among adolescents ages 12-18 years during the period of September 1, 2014, to August 31, 2016. Manual chart review was conducted, and charts were coded for several follow-up care actions (e.g., referral to behavioral health providers and provision of crisis line information) in the year after suicidality endorsement. RESULTS In a sample of 12,690 adolescents, 5.1% endorsed thoughts of death or self-harm, 3.6% reported a lifetime suicide attempt, and 2.4% endorsed serious suicidal ideation within the past month. Manual chart review of a stratified random subsample of 150 of the 643 adolescents who endorsed a lifetime suicide attempt, serious ideation in the past month, or both illustrated the types of follow-up care they received. The PCPs adhered to the system's suicide assessment questions with high fidelity. Follow-up care from PCPs and other providers during the year after suicide risk endorsement was more variable. CONCLUSIONS Findings demonstrate the feasibility of incorporating suicide assessment procedures into depression screening in pediatric primary care and highlight avenues for maximizing preventive care for adolescents at increased risk for suicide.
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Affiliation(s)
- Molly Davis
- Department of Psychiatry (Davis, Beidas, Young) and Department of Medical Ethics and Health Policy (Beidas), Perelman School of Medicine, and Penn Implementation Science Center at the Leonard Davis Institute of Health Economics (Davis, Beidas), University of Pennsylvania, Philadelphia; Department of Child and Adolescent Psychiatry and Behavioral Sciences, and PolicyLab, Children's Hospital of Philadelphia, Philadelphia (Rio, Bush, Young); Center for Anxiety and Related Disorders, Boston University, Boston (Farley)
| | - Victoria Rio
- Department of Psychiatry (Davis, Beidas, Young) and Department of Medical Ethics and Health Policy (Beidas), Perelman School of Medicine, and Penn Implementation Science Center at the Leonard Davis Institute of Health Economics (Davis, Beidas), University of Pennsylvania, Philadelphia; Department of Child and Adolescent Psychiatry and Behavioral Sciences, and PolicyLab, Children's Hospital of Philadelphia, Philadelphia (Rio, Bush, Young); Center for Anxiety and Related Disorders, Boston University, Boston (Farley)
| | - Alyssa M Farley
- Department of Psychiatry (Davis, Beidas, Young) and Department of Medical Ethics and Health Policy (Beidas), Perelman School of Medicine, and Penn Implementation Science Center at the Leonard Davis Institute of Health Economics (Davis, Beidas), University of Pennsylvania, Philadelphia; Department of Child and Adolescent Psychiatry and Behavioral Sciences, and PolicyLab, Children's Hospital of Philadelphia, Philadelphia (Rio, Bush, Young); Center for Anxiety and Related Disorders, Boston University, Boston (Farley)
| | - Morgan L Bush
- Department of Psychiatry (Davis, Beidas, Young) and Department of Medical Ethics and Health Policy (Beidas), Perelman School of Medicine, and Penn Implementation Science Center at the Leonard Davis Institute of Health Economics (Davis, Beidas), University of Pennsylvania, Philadelphia; Department of Child and Adolescent Psychiatry and Behavioral Sciences, and PolicyLab, Children's Hospital of Philadelphia, Philadelphia (Rio, Bush, Young); Center for Anxiety and Related Disorders, Boston University, Boston (Farley)
| | - Rinad S Beidas
- Department of Psychiatry (Davis, Beidas, Young) and Department of Medical Ethics and Health Policy (Beidas), Perelman School of Medicine, and Penn Implementation Science Center at the Leonard Davis Institute of Health Economics (Davis, Beidas), University of Pennsylvania, Philadelphia; Department of Child and Adolescent Psychiatry and Behavioral Sciences, and PolicyLab, Children's Hospital of Philadelphia, Philadelphia (Rio, Bush, Young); Center for Anxiety and Related Disorders, Boston University, Boston (Farley)
| | - Jami F Young
- Department of Psychiatry (Davis, Beidas, Young) and Department of Medical Ethics and Health Policy (Beidas), Perelman School of Medicine, and Penn Implementation Science Center at the Leonard Davis Institute of Health Economics (Davis, Beidas), University of Pennsylvania, Philadelphia; Department of Child and Adolescent Psychiatry and Behavioral Sciences, and PolicyLab, Children's Hospital of Philadelphia, Philadelphia (Rio, Bush, Young); Center for Anxiety and Related Disorders, Boston University, Boston (Farley)
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27
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Identification and Management of Adolescent Depression in a Large Pediatric Care Network: Erratum. J Dev Behav Pediatr 2020; 41:202. [PMID: 32235176 DOI: 10.1097/dbp.0000000000000810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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