Recommendations for Depression Screening in Adolescents

The U.S. Preventative Services Task Force (USPSTF) released recommendations on March 30, 2009 regarding depression screening in children and adolescents. With some qualifications, the task force found enough benefits to endorse screening of teens 12 to 18 years of age, but fell short of recommending that children between the ages of 7 to 11 years old be routinely assessed for clinical depression.

Depression

• The task force addressed major depressive disorder (MMD), not the many milder forms in the spectrum of depressive disorders. MMD risk factors can be tricky to assess, but may include the depression of family members, especially parents, other illnesses, negative life experiences and substance abuse.
  Clinical depression may be characterized by persistent sadness lasting more than two weeks, loss of interest in activities, social isolation, anger and sleep problems. An increased risk of suicide in depressed youth makes it the third leading cause of death among those 15 to 24 in the United States, according to the Centers for Disease Control and Prevention.

Screening

• Screening sites included in nine studies were mostly school-based (six), with one in a community setting and two in primary care clinics. The USPSTF was satisfied with the overall accuracy of screening tests, such as the Patient Health Questionnaire for Adolescents and the Beck Depression Inventory.
  However, the few studies available for review on younger children demonstrated poorer performance of these tools. The USPSTF found that there was insufficient evidence to recommend either for or against depression screening in children ages 7 to 11, pointing to gaps in research studies of that group.

Treatment

• The risks of selective serotonin uptake inhibitors (SSRI) medications in children and adolescents may include a 2 percent increase in suicide and a 7 percent increase in the development of bipolar disorder. The task force was thus prompted to qualify their recommendations for depression screening in teens. The benefits outweigh the risks, it concluded, only when there are adequate systems in place to ensure "accurate diagnosis, psychotherapy (cognitive-behavioral or interpersonal), and follow-up" care.
  In its report, the USPSTF included recommendations of the Society for Adolescent Medicine, which supports the use of SSRIs when clinically warranted "with close monitoring for emergent suicidality, hostility, agitation, mania or unusual changes in behavior." The task force report also included the American Medical Association's position that teens who may be at risk due to family problems or other factors should be screened for clinical depression.
  The USPSTF called for more studies evaluating collaborative care and case management for depressed youth and for research that compares the effectiveness of pharmacological and non-pharmacological treatment. The task force also indicated a need for studies to find the causes of depression in children and adolescents.