If your child has been diagnosed with depression or will be evaluated for depression, you may have heard of the Children's Depression Inventory (CDI). A computerised screening instrument for adolescent depression: population-based validation and application to a two-phase case-control study. This is not a diagnostic tool. Adults. Journal of Psychosomatic Research. FINANCIAL DISCLOSURE: The authors have indicated they have no financial relationships relevant to this article to disclose. Started in 1995, this collection now contains 6881 interlinked topic pages divided into a tree of 31 specialty books and 737 chapters. Maternal Depression. The USPSTF found no direct evidence on the harms of screening for MDD in adolescents. This table is not exhaustive, and other screening tools may be available. No studies included children aged <11 years. The USPSTF found 5 good- or fair-quality studies regarding the accuracy of MDD screening instruments in children and adolescents. A modified version of the EPDS is included as part of the Family Questions section in the Survey of Well-being of Young Children (SWYC). Depression screening Teens Screening recommended annually beginning at 11 years of age. The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening for MDD in children aged ≤11 years (I statement). The EPDS is easy to administer and has proven to be an effective screening tool. • PHQ-9 Modified for • Pediatric Symptom Checklist (PSC-Y) A positive result on an initial screening test does not necessarily indicate the need for treatment. Methods. 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 patients are adequately monitored (Fig 1). García, MD, MPH (Pima County Department of Health, Tucson, AZ); Matthew Gillman, MD, SM (Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA); Jessica Herzstein, MD, MPH (independent consultant, Washington, DC); Alex R. Kemper, MD, MPH, MS (Duke University, Durham, NC); Alex H. Krist, MD, MPH (Fairfax Family Practice, Fairfax, and Virginia Commonwealth University, Richmond, VA); Ann E. Kurth, PhD, RN, MSN, MPH (New York University, New York, NY); Douglas K. Owens, MD, MS (Veterans Affairs Palo Alto Health Care System, Palo Alto, and Stanford University, Stanford, CA); William R. Phillips, MD, MPH (University of Washington, Seattle, WA); Maureen G. Phipps, MD, MPH (Brown University, Providence, RI); and Michael P. Pignone, MD, MPH (University of North Carolina, Chapel Hill, NC). Screening for adolescent depression: a comparison of depression scales. For best results, it is recommended that users review available instruction manuals before administering, scoring, and analyzing results of the scoring tools. The CDI was tested on a large group that represents the population of children in the United States. Address correspondence to USPSTF Senior Project Coordinator, 5600 Fishers Ln, Rockville, MD 20857. RECOMMENDATION: The USPSTF recommends screening for MDD in adolescents aged 12 to 18 years. Morbidity in children and adolescents may be demonstrated through decreased school performance, poor social functioning, early pregnancy, increased physical illness, and substance abuse. Block, MD, What You Should Know About Childhood Depression. Center for Epidemiological Studies Depression Scale for Children (CES-DC) The Center for Epidemiological Studies Depression Scale for Children (CES-DC) is a 20-item self-report depression inventory with possible scores ranging from 0 to 60. The CDI is used to scale the severity of depressive symptoms in children. The school can also be included in the treatment plan. As a result, a number of studies included in the 2009 review were not included in the current review. MDD also increases the risk for suicide. One recent RCT (N = 101) evaluated a 12-month collaborative care intervention in adolescents aged 13 to 17 years who screened positive for depression (60% with MDD) in 9 primary care clinics within 1 health system.17 The intervention was based on the Improving Mood-Promoting Access to Collaborative Treatment model and was adapted for adolescents. The patient health questionnaire for adolescents: validation of an instrument for the assessment of mental disorders among adolescent primary care patients. With each question, think about how you've been feeling over the last 2 weeks. The study did not report other outcomes or stratify results according to age, race, or ethnicity. Information on this topic and other related recommendations from the Community Preventive Services Task Force is available at www.thecommunityguide.org/mentalhealth/index.html. Other psychosocial risk factors for MDD include childhood abuse or neglect, exposure to traumatic events (including natural disasters), loss of a loved one or romantic relationship, family conflict, uncertainty about sexual orientation, low socioeconomic status, and poor academic performance. FPnotebook.com is a rapid access, point-of-care medical reference for primary care and emergency clinicians. The 2 BDI studies reported sensitivity ranging from 84% to 90% and specificity ranging from 81% to 86% when a cutoff score of 11 was applied.6,7 One study7 reported a higher area under the curve for male subjects than for female subjects, but neither of the BDI studies reported results according to age or ethnicity. Clinicians should understand the evidence but individualize decision-making to the specific patient or situation. It consists of 20 items related to depression that the child or adolescent rates on a scale ranging from “Not at All” to “A Lot”. The USPSTF does not consider the costs of providing a service in this assessment. New York: Multi-health Systems, Inc.; 1992. These essential functions can be provided through a wide range of arrangements related to clinician types and settings. (0) Not at If you’re 16 or over, this mood self-assessment can help you better understand how you've been feeling recently. Initial screening in patients who may have depression NICE recommends that any patient who may have depression (especially those with a past history of depression or who suffer from a chronic physical illness associated with functional impairment) should be asked the following two questions [ … Hospital Anxiety and Depression Scale (or HADS) – Used for Anxiety & Depression can be used in community as well as hospital. The USPSTF recommends screening for major depressive disorder (MDD) in adolescents aged 12 to 18 years. The USPSTF commissioned a systematic evidence review to update the 2009 USPSTF recommendation on screening for child and adolescent MDD among primary care populations.3,4 To focus on the population most likely to benefit from screening and intervention, the scope of the review was narrowed to focus on screening for and treatment of MDD. It is a 14 question Psychological screening tool assessing the severity of symptoms. Recommended Visit. In instances in which treatment is recommended, treatment can be initiated by the screening provider or through referral to another set of treatment providers. 1 Month 2 Month 4 Month 6 Month. Using Child Behavior Checklist (CBCL) to Assess Depression, The PHQ-9: Patient Healthcare Questionnaire for Depression. For very young children, involving parents in treatment is key. Bright Futures Tool & Resource Kit econd dition User Guide and Instructions for Toolkit Implementation Making the Most of the Supporting Materials in the Toolit Links to Commonly Used Screening Instruments and Tools The American Academy of Pediatrics does not approve nor endorse any specific tool for screening purposes. This question is for testing whether or not you are a human visitor and to prevent automated spam submissions. Lauren DiMaria is a member of the Society of Clinical Research Associates and childhood psychology expert. Screening for Depression in Children and Adolescents: Clinical Summary. Centers for Disease Control and Prevention. Aron Janssen, MD is board certified in child, adolescent, and adult psychiatry and is the vice chair of child and adolescent psychiatry Northwestern University. This recommendation focuses on screening for MDD and does not address screening for other depressive disorders, such as minor depression or dysthymia. AHRQ Publication No. Gundersen Health System Family Medicine Residency, La Crosse, WI. The USPSTF recommends that screening be implemented with adequate systems in place to ensure accurate diagnosis, effective treatment, and appropriate follow-up. Little is known about the prevalence of MDD in children aged ≤11 years. The PHQ-A study had the highest positive predictive value.5 The authors did not report a diagnostic cutoff score but reported sensitivity for a positive test of 73% and specificity of 94%. Recognising and responding to adolescent depression in general practice: developing and implementing the Therapeutic Identification of Depression in Young people (TIDY) programme. [published online ahead of print February 9, 2016]. Screening should be implemented with adequate systems in place to ensure accurate diagnosis, effective treatment, and appropriate follow-up (B recommendation). Depression can be managed in the primary care or specialist setting or managed collaboratively in both settings. If providers choose, they can “pre - screen” with PHQ-2 to determine if a longer standardized screening tool is needed. Data and Statistics on Children's Mental Health. Reliability and Validity of the Center for Epidemiologic Studies Depression Scale in a Population-Based Cohort of Middle-Aged U.S. FUNDING: The US Preventive Services Task Force is an independent, voluntary body. Only a professional trained on the properties of the CDI can accurately interpret the results. Especially in children, the inability to concentrate triggered by depression can look like distractibility from ADHD. Important Information: Diagnostic criteria for a major depressive episode are slightly different for adults and children or adolescents in the DSM-IV-TR. Escitalopram in the treatment of adolescent depression: a randomized placebo-controlled multisite trial. It can also be used as an instrument to monitor changes in depression symptoms over time. A number of comments focused on the phrase “adequate systems.” Some commenters requested a more detailed definition of what constitutes an “adequate system” for screening, others recommended removing the conditional term “when,” and others recommended that the requirement for adequate systems be stronger. A variety of tools can be used for screening and risk assessment such as: A ... Assess the risk of self-harm and suicide – for more information, see the CKS topics on Depression, Depression in children and Self-harm. Cognitive-behavioral therapy is one form of therapy that is used to treat anxiety or depression, particularly in older children. In addition, studies of paroxetine were excluded because of the 2003 FDA recommendation that this agent not be used to treat MDD in children and adolescents because of reports of possible suicidal ideation and suicide attempts in children and adolescents taking paroxetine for depression. In addition to screening tools, the table includes tools that may be used for primary care assessment of children’s global functioning and assessment of children presenting with the most common problems encountered in primary care—anxiety, depression, inattention and impulsivity, disruptive behavior or aggression, substance abuse, Finally, inadequate support and follow-up may result in treatment failures or harms, as indicated by the FDA boxed warning. Risk factors for MDD in children and adolescents include female gender, older age, family (especially maternal) history of depression, previous episode of depression, other mental health/behavioral problems, chronic medical illness, overweight and obesity, and, in some studies, Hispanic race/ethnicity. Evaluation of the Patient Health Questionnaire-9 Item for Detecting Major Depression Among Adolescents. Mental Health: Screening Tools and Rating Scales. You can call Samaritans free on 116 123 if you want to talk to someone now. For example, because children don't have the same sophistication as adults related to understanding and reporting their emotions, their responses may not reflect their true emotional state. A list of the current USPSTF members is available at www.uspreventiveservicestaskforce.org/Page/Name/our-members. Trial outcomes included treatment response, which was defined differently across studies; symptom severity; and global functioning. Treatment options for MDD in children and adolescents include pharmacotherapy, psychotherapy, collaborative care, psychosocial support interventions, and complementary and alternative medicine approaches. Treatment for Adolescents With Depression Study (TADS) Team. This guideline includes new and updated recommendations on: The US Preventive Services Task Force (USPSTF) makes recommendations about the effectiveness of specific preventive care services for patients without related signs or symptoms. Some researchers have also observed that children who do not have age-appropriate reading skills may receive an inaccurate diagnosis on the basis of their CDI score. In 2 nationally representative US surveys, ∼8% of adolescents reported having MDD in the past year. In some children and adolescents with MDD, these symptoms may present as periods of disruptive mood and irritability rather than as a sad mood and may last for weeks, months, or even years. Depression Screening Tools. It was created by clinicians and researchers expert in the area of adolescent depression and the application of various scales and tools in clinical, research and institutional settings. It would be helpful to quantify the proportion of screen-detected subjects who are treated or referred, as well as their willingness and ability to obtain assessment and treatment. DESCRIPTION: This article describes the update of the 2009 US Preventive Services Task Force (USPSTF) recommendation on screening for major depressive disorder (MDD) in children and adolescents. Newer studies do not provide much additional evidence on treatment harms in children and adolescents but do not suggest more risks. While the CDI is good at detecting the presence of depressive symptoms, it is not the best at determining their severity. The Community Preventive Services Task Force recommends collaborative care for the management of depressive disorders, based on strong evidence of effectiveness in improving depression symptoms, adherence and response to treatment, and remission and recovery from depression. The Pediatric Symptom Checklist is a psychosocial screen designed to facili- tate the recognition of cognitive, emotional, and behavioral problems so that appropriate interventions can be initiated as early as possible. This guideline covers identifying and managing depression in children and young people aged 5 to 18 years. REFERENCES Weissman MM, Orvaschel H, Padian N. 1980. Depression Scale for Children (DSC) The Center for Epidemiological Studies Depression Scale for Children (DSC) is a 20-item self-report for children and adolescents ages 6 to 17 years that screens for depression. Some research indicates, however, that the test is not appropriate for children who have reading difficulties. The STAR Center resources focus on early childhood screening. *For children ages 8 to 11, it is recommended that the clinician explain all questions, or have the child answer the questionnaire sitting with an adult in case they have any questions. Among children and adolescents aged 8 to 15 years, 2% of boys and 4% of girls reported having MDD in the past year. These chapters and Chapter 3, Office and Network Systems to Support Mental Health Care, offer general guidance concerning the selection of tools for use in primary care. Author Information . Children with depressive disorders have increased health care costs (including general medical and mental health care) compared with children without mental health diagnoses or children with other mental health diagnoses (except conduct disorder). Two studies evaluated the benefits of cognitive behavioral therapy (CBT) compared with placebo (waitlist control or clinical monitoring) in adolescents with MDD and reported nonsignificant improvements in response (43.2% vs 34.8%) or recovery (odds ratio [OR], 2.15 [95% confidence interval (CI), 0.87–5.33]).10,11,16 Results for remission (16% vs 17%) were not significantly different between the CBT and placebo groups. Postpartum depression is the most common complication of childbearing. • Use of screening tools to aide in identification of children and adolescents with depression and anxiety disorders . Evidence-based screening tools that include reports from parents and early childhood professionals can help parents and healthcare professionals talk about the child’s development in a systematic way. PHQ-2 b • Bright Futures sample form • Instructions. If you are concerned about depression in your child, it is important to consult with your child's pediatrician or other mental health professional. Patient Health Questionnaires (PHQs) Everything feels more challenging when you're dealing with depression. Therefore, the USPSTF concludes with moderate certainty that screening for MDD in adolescents aged 12 to 18 years is associated with moderate net benefit. Understanding Your Liebowitz Social Anxiety Scale (LSAS) Results. No trials of psychotherapy or combined interventions in children examined harms. 5 Depression: Incidence/Prevalence • In 2015, 30% of H.S. 116. The USPSTF concludes with moderate certainty that screening for MDD in adolescents aged 12 to 18 years has a moderate net benefit. Five SSRI trials reported on harms and found no significant differences between intervention groups, although none of the studies was powered to detect these differences. The 2005 NHANES found that among children and adolescents aged 8 to 15 years, 2% of boys and 4% of girls reported having MDD in the past year. Studies with long-term follow-up are also needed. Patients randomly assigned to the collaborative care group had an initial in-person session that included their parents, choice of treatment type(s), and regular follow-up with depression care managers (28% received psychotherapy alone, 4% received pharmacotherapy alone, and 54% received both). Evidence on the harms of psychotherapy and the combination of psychotherapy and SSRIs in children is limited. Rather, the goal is for the results of the test to be shared with your doctor to inform further conversations about diagnosis and treatment. Included here are two versions, the parent … The majority of trials were restricted to adolescents aged 12 to 14 years and older; only 2 of the SSRI trials included children aged 7 or 8 years. Screening negative on a screening test, however, does not always preclude referral when clinical judgment or parental concerns suggest otherwise. What Parents Should Know About Childhood Depression, Benefits of Children Taking Antidepressants Can Outweigh the Risks, Psilocybin Effective for Treating Major Depressive Disorder, Research Suggests, The 7 Best Online Therapy Programs for Kids in 2021. Functioning and quality of life in the Treatment for Adolescents with Depression Study (TADS). METHODS: The USPSTF reviewed the evidence on the benefits and harms of screening, accuracy of primary care–feasible screening tests, and benefits and harms of treatment with psychotherapy, medications, and collaborative care models in patients aged 7 to 18 years. These studies found no increased risk for suicidality associated with the use of antidepressant therapy. The number of items, administrative time to complete screening, and appropriate ages for screening vary. The USPSTF found no studies of screening instruments for depression in children aged ≤11 years in primary care (or comparable) settings and concludes that the evidence is inadequate. Numerous instruments have been developed for use in primary care and have been used in adolescents. The short form of the test is generally used as a screening tool, while the long-form is used more often in the diagnosis of depression in children. It is a compilation of tools that are potentially useful at each stage of a clinical process through which mental health content can be integrated into pediatric primary care. Edinburgh Postpartum Depression Scale (EPDS) a. POPULATION: This recommendation applies to children and adolescents aged ≤18 years who do not have an MDD diagnosis. The USPSTF found no studies that directly evaluated whether screening for MDD in children aged ≤11 years in primary care (or comparable) settings leads to improved health and other outcomes, and found inadequate evidence on the benefits of treatment in children detected through screening. For best results, it is recommended that users review available instruction manuals prior to administering, scoring, and analyzing results of the scoring tools. Ten percent of children aged 5 to 12.9 years and 19% of adolescents aged 13 to 17.9 years with MDD attempt suicide.2, The mean age of onset of MDD in childhood and adolescence is ∼14 to 15 years, and onset is earlier in girls than in boys. from the PHQ-9 that is used for adults. What Is the Edinburgh Postnatal Depression Scale? The CDI was developed by Maria Kovacs in order to more easily diagnose depression in children. Data on the accuracy of MDD screening instruments in younger children are limited. 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