Depression screening in adolescents in the United States: a national study of ambulatory office-based practice

Abstract

Objective: To determine the frequency of depression screening during ambulatory, office-based visits for adolescents seen in general/family medicine or pediatric practices in the United States using nationally representative data; to determine the patient-, provider-, and visit-level factors associated with depression screening during ambulatory visits to inform recommendations to promote screening.

Methods: This cross-sectional study used the 2005-2010 National Ambulatory Medical Care and National Hospital Ambulatory Medical Care Surveys. Data were limited to ambulatory, office-based visits to general/family medicine or pediatrics clinics for adolescents aged 12 to 18 years who did not have a documented diagnosis of depression.

Results: Depression screening was rare (0.2%; 95% confidence interval [CI] 0.1-0.3), and it was 80% less likely to occur during visits for Hispanic compared to non-Hispanic white adolescents (adjusted odds ratio [aOR] 0.2, 95% CI 0.1-0.7). Depression screening was 9.1 times more likely in the Northeast compared to the West (aOR 9.1, 95% CI 2.2-38.1) if there were no visits within past 12 months compared to 6 or more visits (aOR 6.1; 95% CI 1.8-20.4), and if stress management (aOR 24.2, 95% CI 11.8-49.5) or other mental health counseling (aOR 5.2, 95% CI 1.2-23.6) were provided.

Conclusions: Depression screening for adolescents is rare and is associated with racial/ethnic and regional disparities. The integration of behavioral and mental health services within the patient-centered medical home might assist providers in identifying and treating depression and in addressing such disparities.

Keywords: adolescent depression; adolescents; screening.