All Hands on Deck: Addressing Adolescent Depression in Pediatric Primary Care

Area of Science:

• Pediatric primary care
• Adolescent mental health
• Depression screening and intervention

Background:

• Adolescent depression is a significant public health concern.
• Primary care settings offer opportunities for early identification and intervention.
• The Patient Health Questionnaire-9 Item Modified for Adolescents (PHQ-9A) is a key screening tool.

Purpose of the Study:

• To determine the prevalence of elevated depression symptoms in adolescents using the PHQ-9A.
• To characterize interventions provided by primary care providers (PCPs) and behavioral health clinicians (BHCs).
• To identify factors associated with improved PHQ-9A scores at follow-up visits.

Main Methods:

• A mixed-methods approach was used, analyzing clinical informatics data from 2,107 adolescents (aged 11-18).
• Data included demographics, PHQ-9A scores, and electronic medical records from January 2017 to August 2018.
• Statistical analyses included descriptive statistics, chi-square tests, and point biserial correlations.

Main Results:

• 13% (277) of adolescents had elevated PHQ-9A scores.
• 40 distinct actions were identified from PCPs and BHCs in response to elevated scores.
• Key factors for improved PHQ-9A scores included PCP referrals to integrated behavioral health and specific BHC interventions like follow-up check-ins, risk assessments, and psychoeducation.

Conclusions:

• Primary care settings are crucial for addressing adolescent depression.
• Integrated behavioral health services and targeted interventions by PCPs and BHCs are effective.
• Findings inform screening processes and clinical practices for adolescent mental health in primary care.