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. 2012 Dec;130(6):e1541-8.
doi: 10.1542/peds.2012-0450. Epub 2012 Nov 19.

Predictors of persistence after a positive depression screen among adolescents

Laura P Richardson  1 , Elizabeth McCauley, Carolyn A McCarty, David C Grossman, Mon Myaing, Chuan Zhou, Julie Richards, Carol Rockhill, Wayne Katon
Affiliations

Predictors of persistence after a positive depression screen among adolescents

Laura P Richardson et al. Pediatrics. 2012 Dec.

Abstract

Objective: To examine predictors of depression persistence after a positive screening test to inform management protocols for screened youth.

Methods: We conducted a cohort study of 444 youth (aged 13-17 years) from a large health care delivery system. Youth with depressive symptoms, based on a 2-item depression screen, were oversampled for the baseline interview. Baseline assessments included the Patient Health Questionnaire 9-item (PHQ-9) depression screen as well as clinical factors that were hypothesized to influence depression persistence (family history of depression, functional impairment, perceived social support, anxiety symptoms, externalizing symptoms, and medical comorbidity). Logistic regression analysis was used to examine factors associated with the persistence of depression at 6 months postbaseline.

Results: Of 113 youth with a positive baseline screen (PHQ-9 ≥11), 47% and 35% continued to be positive at 6-week and 6-month follow-up, respectively. After controlling for treatment status, only 2 factors were significantly associated with depression persistence at 6 months: baseline depressive symptom score and continuing to have a positive screen at 6 weeks. For each 1-point increase on the PHQ-9 score at baseline, youth had a 16% increased odds of continuing to be depressed at 6 months (odds ratio: 1.16, 95% confidence interval: 1.01-1.34). Youth who continued to screen positive 6 weeks later had almost 3 times the odds of being depressed at 6 months (odds ratio: 2.89, 95% confidence interval: 1.09-7.61).

Conclusions: Depressive symptom severity at presentation and continued symptoms at 6 weeks postscreening are the strongest predictors of depression persistence. Patients with high depressive symptom scores and continued symptoms at 6 weeks should receive active treatment.

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Figures

FIGURE 1
FIGURE 1
Study enrollment flow diagram.
FIGURE 2
FIGURE 2
PHQ-9 depression status at 6 weeks and 6 months among youth who screened positive (PHQ-9 ≥11) and negative (PHQ-9 <11) for depression at baseline.
FIGURE 3
FIGURE 3
Depression severity status on the PHQ-9 as a predictor of persistence at 6 months.
See this image and copyright information in PMC

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References

    1. Screening for major depressive disorder in children and adolescents, topic page, March 2009. Available at: www.uspreventiveservicestaskforce.org/uspstf/uspschdepr.htm. Accessed July 10, 2012
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