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Evaluation of a Depression Screening Program in Pediatric Orthopaedic Sports Clinics: Identifying At-Risk Adolescents
Reinaldo E Colon-Morillo1,2, Katina Kartalias2, Tracey P Bryan1
1Rady Children's Hospital, San Diego, California, USA.
Background:
Mental health is a contributing factor to the overall well-being of patients, and the 2-question Patient Health Questionnaire (PHQ-2) and 9-question Patient Health Questionnaire (PHQ-9) are reliable in-clinic tools to assess depression and self-harm. The prevalence of adolescents with depression symptoms within a pediatric orthopaedic sports clinic has not been assessed.
Hypothesis:
That rates of depression and risk of self-harm would vary based on presenting pathology among adolescents sustaining a sports-related injury.
Study Design:
Cross-sectional study; Level of evidence, 3.
Methods:
A query of the institutional electronic medical record was performed to identify all patients aged 12 to 21 years who were administered the PHQ-2 or PHQ-9 over a 2.3-year period within pediatric orthopaedic sports clinics. The rate of a positive screen prompting administration of PHQ-9 (PHQ-2 score ≥3), rate of depression risk (PHQ-9 score ≥10), and rate of patients indicating self-harm (affirmative score on question 9) were evaluated. Patients were placed into 4 broad diagnostic categories: knee instability, knee other, shoulder pathology, or other sports-related injuries. Multivariate binary logistic regression was performed to identify available patient and diagnosis predictors of self-harm risk.
Results:
A total of 3298 patients were screened in pediatric orthopaedic sports clinics from 2018 to 2021. The overall positive screen rate (PHQ-2) was 4.2% (n = 138), the depression risk rate (PHQ-9) was 1.9% (n = 63), and the self-harm rate was 0.9% (n = 29). Self-harm showed a significant difference, with shoulder and knee instability having the highest rate. Black/African American race (OR, 3.8; 95% CI, 1.3-11; P = .02), female sex (OR, 3.0; 95% CI, 1.3-6.9; P = .01), public/government insurance (OR, 2.2; 95% CI, 1.03-4.8; P = .041), shoulder pathology (OR, 3.4; 95% CI, 1.3-9.4; P = .016), and knee instability diagnosis (OR, 2.8; 95% CI, 1.2-6.5; P = .02) were associated with an increased risk of self-harm.
Conclusion:
This study demonstrated a 2% rate of depression risk and a 1% rate of self-harm risk in adolescents treated within pediatric orthopaedic sports clinics. Race, sex, and public/government insurance were found to be predictive factors. Knowledge of risk factors can help increase awareness and recognition of potential mental health conditions that may need to be addressed during treatment for adolescents with sports-related injuries. The authors recommend that adolescents >12 years of age complete this quick assessment at the start of their orthopaedic sports clinic encounter.
