Physician Preferences for Universal Routine Depression Screening for Adolescents in Primary Care

Universal adolescent depression screening is recommended as routine primary care, but it is unclear how best to implement it. Systematic evaluation of physician preferences can support optimal screening implementation.

To assess primary care physicians' preferences for different attributes of a universal adolescent depression screening strategy.

In this survey study, a discrete choice experiment was administered to a US physician panel maintained by Qualtrics. Five attributes were identified from prior qualitative work: screening modality, screening location, screening completion time, missed depression cases, and clinical examination time, each with 2 to 3 levels. The survey presented 13 discrete choice questions and physician characteristics' questions. The survey was pretested through cognitive debriefings, piloted to an independent sample, and fielded to the final sample from April to June 2024.

Physicians' preference and importance coefficients for different screening strategies using time to assess willingness to make trade-offs for changes in attribute levels were estimated. Data were analyzed using conditional logit and latent class models.

Among the 181 physician respondents (96 males [53.0%]), 90 (49.7%) were in urban settings, 112 (61.9%) were in a pediatrics primary care specialty, and 68 (37.6%) were in private practice. Conditional logit analyses showed that respondents preferred the least missed depression cases (59.6% importance), shortest clinical examination time (21.0% importance), 3-minute screening time (12.9% importance), private area provision (3.8% importance), and electronic modality (2.7% importance). Physicians reported their willingness to spend 37.3 minutes (95% CI, 32.1-42.5 minutes) during examinations per patient to reduce missed diagnoses from 10% to 5%. In the latent class analysis, 3 subgroups were identified. The diagnostic accuracy-sensitive group (n = 66) prioritized the top important attribute, missed depression cases (75.1% importance), more than other groups. The clinic time-sensitive group (n = 33) prioritized shortening examination time (35.2% importance) more than other groups. The screener type-specific group (n = 82) prioritized 3-minute screening (25.8% importance) and electronic modality (10.2% importance) more than other groups.

In this survey study, primary care physicians preferred identifying adolescent depression accurately and shortening well-child examination time. Health systems and payers should consider these preferences for accuracy and efficiency by physicians, who are strongly positioned to identify adolescent depression early and to implement screenings. Further research is needed to better understand family and administrative staff preferences regarding pediatric integrated behavioral health care.