PEDIATRICS Vol. 123 No. 4 April 2009, pp. e716-e735 (doi:10.1542/peds.2008-2415)
REVIEW ARTICLE |
Screening for Child and Adolescent Depression in Primary Care Settings: A Systematic Evidence Review for the US Preventive Services Task Force
Center for Health Research, Kaiser Permanente, Portland, Oregon; Oregon Evidence-Based Practice Center, Portland, Oregon
CONTEXT. Depression among youth is a disabling condition that is associated with serious long-term morbidities and suicide.
OBJECTIVE. To assess the health effects of routine primary care screening for major depressive disorder among children and adolescents aged 7 to 18 years.
METHODS. Medline, the Cochrane Central Registry of Controlled Trials, PsycInfo, the Cochrane Database of Systematic Reviews, recent systematic reviews, experts, and bibliographies from selected studies were the data sources. The studies selected were fair- and good-quality (on the basis of US Preventive Services Task Force criteria) controlled trials of screening and treatment (selective serotonin reuptake inhibitor and/or psychotherapy), diagnostic accuracy studies, and large observational studies that reported adverse events. Two reviewers quality-graded each article. One reviewer abstracted relevant information into standardized evidence tables, and a second reviewer checked key elements.
RESULTS. We found no data describing health outcomes among screened and unscreened populations. Although the literature on diagnostic screening test accuracy is small and methodologically limited, it indicates that several screening instruments have performed fairly well among adolescents. The literature on treatment efficacy of selective serotonin reuptake inhibitors and/or psychotherapy is also small but includes good-quality randomized, controlled trials. Available data indicate that selective serotonin reuptake inhibitors, psychotherapy, and combined treatment are effective in increasing response rates and reducing depressive symptoms. Not all specific selective serotonin reuptake inhibitors, however, seem to be efficacious. Selective serotonin reuptake inhibitor treatment was associated with a small absolute increase in risk of suicidality (ie, suicidal ideation, preparatory acts, or attempts). No suicide deaths occurred in any of the trials.
CONCLUSIONS. Limited available data suggest that primary care–feasible screening tools may accurately identify depressed adolescents and treatment can improve depression outcomes. Treating depressed youth with selective serotonin reuptake inhibitors may be associated with a small increased risk of suicidality and should only be considered if judicious clinical monitoring is possible.
Key Words: depression • primary care • screening • treatment • children • adolescents
Abbreviations: MDD—major depressive disorder • SSRI—selective serotonin reuptake inhibitor • FDA—Food and Drug Administration • USPSTF—US Preventive Services Task Force • KQ—key question • DARE—Database of Abstracts of Reviews of Effects • CDSR—Cochrane Database of Systematic Reviews • AHRQ—Agency for Healthcare Research and Quality • PHQ-A—Patient Health Questionnaire for Adolescents • BDI-PC—Beck Depression Inventory-Primary Care Version • SDQ—Strengths and Difficulties Questionnaire • RCT—randomized, controlled trial • CI—confidence interval • RD—risk difference • SRE—suicide-related adverse event • RR—relative risk • TADS—Treatment for Adolescents With Depression Study • CBT—cognitive behavioral therapy • IPT-A—interpersonal psychotherapy for adolescents • CCRCT—Cochrane Collaboration Registry of Clinical Trials
Accepted Aug 11, 2008.
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  US Preventive Services Task Force Screening and Treatment for Major Depressive Disorder in Children and Adolescents: US Preventive Services Task Force Recommendation Statement Pediatrics, April 1, 2009; 123(4): 1223 - 1228. [Abstract] [Full Text] [PDF]
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