This article is more than 5 years old. Information may no longer be current.

USPSTF recommends screening adolescents for depression

The U.S. Preventive Services Task Force has issued an update to its recommendations for the screening of depression in children and adolescents.

The B grade recommendation includes changes that reflect evidence of little harm of pharmacotherapy as long as patients are closely monitored, according to the authors.

The USPSTF also concluded that they had insufficient evidence to issue a screening recommendation for major depressive disorder (MDD) in children.

"In 2009, the USPSTF recommended screening for MDD in adolescents (aged 12 to 18 years) when systems are in place to ensure accurate diagnosis, psychotherapy (CBT or interpersonal), and follow-up and concluded that the evidence was insufficient to make a recommendation for children (aged 7 to 11 years)," Albert L. Siu, MD, MSPH, on behalf of the USPSTF, wrote in the Annals of Internal Medicine and Pediatrics. "The current recommendation reaffirms these positions but removes the mention of specific therapies in recognition of decreased concern over the harms of pharmacotherapy in adolescents when they are adequately monitored."

In their review of five studies on screening tests, the USPSTF found "adequate evidence" that screening can accurately identify MDD in adolescents. The authors cited several screening tools that have been developed for primary care use, including the Patient Health Questionnaire for Adolescents (PHQ-A) and the primary care version of the Beck Depression Inventory. The PHQ-A screening tool demonstrated the highest positive predictive value.

In their review of eight studies examining health outcomes and harms for children and adolescents who were treated for MDD, the USPSTF found "adequate evidence" that treatment was associated with "beneficial reductions in symptoms." The studies assessed selective serotonin reuptake inhibitors (SSRIs), including escitalopram, citalopram and fluoxetine, as well as psychotherapy, SSRIs combined with psychotherapy, and collaborative care.

Depression management can occur exclusively in primary care or specialist settings or in a collaborative setting, Siu noted, as long as screening is implemented with systems in place to ensure appropriate care. The agency said that some treatment options will require collaboration.

The USPSTF based its recommendation on their estimation of magnitude of net benefit, noting that approximately 8% of adolescents have reported major depression in the past year.

“Although the data are limited, the USPSTF concludes that the evidence on the frequency of medication-related adverse events in adolescents is adequate to estimate that the magnitude of harms of pharmacotherapy is small if patients are closely monitored,” they wrote. “The USPSTF concludes that the evidence on the harms of pharmacotherapy and collaborative care in adolescents is adequate to estimate that the magnitude of harms is small to none. Therefore, the USPSTF concludes with moderate certainty that screening for MDD in adolescents aged 12 to 18 years is associated with moderate net benefit.” – by Chelsea Frajerman Pardes

Disclosures: The researchers report no relevant financial disclosures.