Implementation of Depression Screening and Global Health Assessment in Pediatric Subspecialty Clinics

Esti Iturralde; Rebecca N Adams; Regan C Barley; Rachel Bensen; Megan Christofferson; Sarah J Hanes; David M Maahs; Carlos Milla; Diana Naranjo; Avni C Shah; Molly L Tanenbaum; Sruthi Veeravalli; K T Park; Korey K Hood

doi:10.1016/j.jadohealth.2017.05.030

Implementation of Depression Screening and Global Health Assessment in Pediatric Subspecialty Clinics

J Adolesc Health. 2017 Nov;61(5):591-598. doi: 10.1016/j.jadohealth.2017.05.030. Epub 2017 Aug 19.

Affiliations

¹ Division of Endocrinology and Diabetes, Department of Pediatrics, Stanford University School of Medicine, Stanford, California.
² Division of Gastroenterology, Department of Pediatrics, Stanford Children's Inflammatory Bowel Disease Center, Stanford University School of Medicine, Stanford, California.
³ Division of Pulmonary Medicine, Stanford Children's CysticFibrosis Center, Department of Pediatrics, Stanford University School of Medicine, Stanford, California.
⁴ Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California.
⁵ Division of Endocrinology and Diabetes, Department of Pediatrics, Stanford University School of Medicine, Stanford, California; Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California. Electronic address: kkhood@stanford.edu.

Abstract

Purpose: Adolescents with chronic illness face greater risk of psychosocial difficulties, complicating disease management. Despite increased calls to screen for patient-reported outcomes, clinical implementation has lagged. Using quality improvement methods, this study aimed to investigate the feasibility of standardized screening for depression and assessment of global health and to determine recommended behavioral health follow-up, across three pediatric subspecialty clinics.

Methods: A total of 109 patients aged 12-22 years (median = 16.6) who were attending outpatient visits for treatment of diabetes (80% type 1), inflammatory bowel disease, or cystic fibrosis completed the 9-item Patient Health Questionnaire (PHQ-9) depression and Patient-Reported Outcomes Measurement Information System (PROMIS) Pediatric Global Health measures on electronic tablets. Patients screening positive on the PHQ-9 received same-day behavioral health assessment and regular phone check-ins to facilitate necessary follow-up care.

Results: Overall, 89% of 122 identified patients completed screening during a 6-month window. Patients completed measures in a timely manner (within 3 minutes) without disruption to clinic flow, and they rated the process as easy, comfortable, and valuable. Depression scores varied across disease type. Patients rated lower global health relative to a previously assessed validation cohort. Depression and global health related significantly to certain medical outcomes. Fifteen percent of patients screened positive on the PHQ-9, of whom 50% confirmed attending behavioral health appointments within 6 months of screening.

Conclusions: A standardized depression and global health assessment protocol implemented across pediatric subspecialties was feasible and effective. Universal behavioral health screening for adolescents and young adults living with chronic disease is necessary to meet programmatic needs in pediatric subspecialty clinics.

Keywords: Cystic fibrosis; Depression; Diabetes; Global health; Inflammatory bowel disease; Mental health; Pediatric; Screening.

MeSH terms

Adolescent
Ambulatory Care Facilities
Chronic Disease / psychology*
Depression / diagnosis*
Female
Health Status*
Humans
Male
Mass Screening / methods*
Pediatrics*
Surveys and Questionnaires

Grants and funding

P30 DK116074/DK/NIDDK NIH HHS/United States