Social Vulnerability and Racial Disparities in Depression Screening of US Adolescents, 2016 to 2021

Objectives. To identify whether sociodemographic disparities exist by evaluating the association between rates of adolescent depression screening, social risk, and race. Methods. We used a US nationwide sample of Highmark Health privately insured adolescents between 2016 and 2021 to estimate the odds of well-visit depression screening receipt as a function of social factors (Social Vulnerability Index [SVI], predicted race). Results. Higher SVI was negatively associated with odds of screening and depended on predicted Black race (P for interaction < .01). Provider type was a strong predictor of screening, with pediatricians more likely to screen than other generalist specialties (odds ratio = 9.64; 95% confidence interval = 9.11, 10.2). Inclusion of variation at the practice location level attenuated the relationship with SVI and accounted for a large proportion of variability in screening (intraclass correlation coefficient = 0.76), although SVI remained significant ( P < .01). Conclusions. Adolescents are more likely to receive a depression screen if they reside in lower social-risk locations or, if likely to identify as Black, higher social-risk locations. Ultimately, screening has strong ties to where an adolescent lives and the type of provider they access. (Am J Public Health. 2025;115(9):1436-1444. https://doi.org/10.2105/AJPH.2025.308149).