Physician Intervention to Positive Depression Screens Among Adolescents in Primary Care

Matthew Aalsma, Ashley M. Zerr, Dillon J. Etter, Fangqian Ouyang, Amy Lewis Gilbert, Rebekah Williams, James A. Hall, Stephen Downs

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Purpose: The objective of this study was to determine the effectiveness of computer-based screening and physician feedback to guide adolescent depression management within primary care. Methods: We conducted a prospective cohort study within two clinics of the computer-based depression screening and physician feedback algorithm among youth aged 12-20 years between October 2014 and October 2015 in Marion County (Indianapolis), Indiana. Results: Our sample included 2,038 youth (51% female; 60% black; mean age = 14.6 years [standard deviation = 2.1]). Over 20% of youth screened positive for depression on the Patient Health Questionnaire-2 and 303 youth (14.8%) screened positive on the Patient Health Questionnaire-9 (PHQ-9). The most common follow-up action by physicians was a referral to mental health services (34.2% mild, 46.8% moderate, and 72.2% severe range). Almost 11% of youth in the moderate range and 22.7% of youth in the severe range were already prescribed a selective serotonin reuptake inhibitor. When predicting mental health service referral, significant predictors in the multivariate analysis included clinic site (40.2% vs. 73.9%; p < .0001) and PHQ-9 score (severe range 77.8% vs. mild range 47.5%; p < .01). Similarly, when predicting initiation of selective serotonin reuptake inhibitors, only clinic site (28.6% vs. 6.9%; p < .01) and PHQ-9 score (severe range 46.7% vs. moderate range 10.6%; p < .001) were significant. Conclusions: When a computer-based decision support system algorithm focused on adolescent depression was implemented in two primary care clinics, a majority of physicians utilized screening results to guide clinical care.

Original languageEnglish (US)
JournalJournal of Adolescent Health
DOIs
StateAccepted/In press - Jan 1 2017

Fingerprint

Primary Health Care
Depression
Physicians
Health
Serotonin Uptake Inhibitors
Mental Health Services
Referral and Consultation
Cohort Studies
Multivariate Analysis
Prospective Studies
Surveys and Questionnaires

Keywords

  • Depression
  • Primary care
  • Screening
  • Treatment

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Public Health, Environmental and Occupational Health
  • Psychiatry and Mental health

Cite this

Physician Intervention to Positive Depression Screens Among Adolescents in Primary Care. / Aalsma, Matthew; Zerr, Ashley M.; Etter, Dillon J.; Ouyang, Fangqian; Gilbert, Amy Lewis; Williams, Rebekah; Hall, James A.; Downs, Stephen.

In: Journal of Adolescent Health, 01.01.2017.

Research output: Contribution to journalArticle

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abstract = "Purpose: The objective of this study was to determine the effectiveness of computer-based screening and physician feedback to guide adolescent depression management within primary care. Methods: We conducted a prospective cohort study within two clinics of the computer-based depression screening and physician feedback algorithm among youth aged 12-20 years between October 2014 and October 2015 in Marion County (Indianapolis), Indiana. Results: Our sample included 2,038 youth (51{\%} female; 60{\%} black; mean age = 14.6 years [standard deviation = 2.1]). Over 20{\%} of youth screened positive for depression on the Patient Health Questionnaire-2 and 303 youth (14.8{\%}) screened positive on the Patient Health Questionnaire-9 (PHQ-9). The most common follow-up action by physicians was a referral to mental health services (34.2{\%} mild, 46.8{\%} moderate, and 72.2{\%} severe range). Almost 11{\%} of youth in the moderate range and 22.7{\%} of youth in the severe range were already prescribed a selective serotonin reuptake inhibitor. When predicting mental health service referral, significant predictors in the multivariate analysis included clinic site (40.2{\%} vs. 73.9{\%}; p < .0001) and PHQ-9 score (severe range 77.8{\%} vs. mild range 47.5{\%}; p < .01). Similarly, when predicting initiation of selective serotonin reuptake inhibitors, only clinic site (28.6{\%} vs. 6.9{\%}; p < .01) and PHQ-9 score (severe range 46.7{\%} vs. moderate range 10.6{\%}; p < .001) were significant. Conclusions: When a computer-based decision support system algorithm focused on adolescent depression was implemented in two primary care clinics, a majority of physicians utilized screening results to guide clinical care.",
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AB - Purpose: The objective of this study was to determine the effectiveness of computer-based screening and physician feedback to guide adolescent depression management within primary care. Methods: We conducted a prospective cohort study within two clinics of the computer-based depression screening and physician feedback algorithm among youth aged 12-20 years between October 2014 and October 2015 in Marion County (Indianapolis), Indiana. Results: Our sample included 2,038 youth (51% female; 60% black; mean age = 14.6 years [standard deviation = 2.1]). Over 20% of youth screened positive for depression on the Patient Health Questionnaire-2 and 303 youth (14.8%) screened positive on the Patient Health Questionnaire-9 (PHQ-9). The most common follow-up action by physicians was a referral to mental health services (34.2% mild, 46.8% moderate, and 72.2% severe range). Almost 11% of youth in the moderate range and 22.7% of youth in the severe range were already prescribed a selective serotonin reuptake inhibitor. When predicting mental health service referral, significant predictors in the multivariate analysis included clinic site (40.2% vs. 73.9%; p < .0001) and PHQ-9 score (severe range 77.8% vs. mild range 47.5%; p < .01). Similarly, when predicting initiation of selective serotonin reuptake inhibitors, only clinic site (28.6% vs. 6.9%; p < .01) and PHQ-9 score (severe range 46.7% vs. moderate range 10.6%; p < .001) were significant. Conclusions: When a computer-based decision support system algorithm focused on adolescent depression was implemented in two primary care clinics, a majority of physicians utilized screening results to guide clinical care.

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