Depression in adolescence: Screening and diagnosis in primary care in an integrated healthcare system

Adolescent depression screening in primary care is recommended yet little is known about its implementation and outcomes. We assessed rates of screening, "positive" screening and later diagnosis of depression.

This retrospective cohort study included 751,876 adolescents aged 11-17.99 years from 1/1/2017-12/31/2021 at a large integrated healthcare system in Southern California with comprehensive electronic medical records (EMR). Screening for depression was implemented at primary care using the abbreviated Patient Health Questionnaire (PHQ). All data were extracted from EMR. Rates of depression screening completion, screening "positive", and subsequent diagnosis of depression were reported overall; by age, gender, race/ethnicity, and estimated household income with Poisson regression comparing rates across subgroups.

Among the adolescents, 613,662 (81.6 %) had primary care visits, of these, 403,890 (65.8 %) completed at least one screening during the study period. Although statistically significant, screening rates were generally comparable across age, gender, household income and race/ethnicity. A total of 9.7 % adolescents screened "positive", with some differences within subgroups. Among adolescents with "positive" screening, 30.2 % were diagnosed with depression within two years after the first "positive" screening, with some differences within subgroups. Adolescents self-identified as other gender had substantially higher rate of "positive" screening and diagnosis rate; however, the data was based on a sample size less than 50.

Depression screening can be administered at primary care for adolescents starting as early as age 11 years old. Screening with PHQ at primary care as part of standard preventive care can effectively identify adolescents at risk for depression.