Depression and Suicide-Risk Screening Results in Pediatric Primary Care

Pediatrics. 2021 Jul;148(1):e2021049999. doi: 10.1542/peds.2021-049999. Epub 2021 Jun 7.


Background and objectives: Depression is common, and suicide rates are increasing. Adolescent depression screening might miss those with unidentified suicide risk. Our primary objective in this study was to compare the magnitude of positive screen results across different approaches.

Methods: From June 2019 to October 2020, 803 mostly Medicaid-enrolled adolescents aged ≥12 years with no recent history of depression or self-harm were screened with the Patient Health Questionnaire-9 Modified for Adolescents (PHQ-9A) and the Ask Suicide-Screening Questions (ASQ) across 12 primary care practices. Two PHQ-9A screening strategies were evaluated: screening for any type of depression or other mental illness (positive on any item) or screening for major depressive disorder (MDD) (total score ≥10).

Results: Overall, 56.4% of patients screened positive for any type of depression, 24.7% screened positive for MDD, and 21.1% screened positive for suicide risk. Regardless of PHQ-9A screening strategy, the ASQ identified additional subjects (eg, 2.2% additional cases compared with screening for any type of depression or other mental illness and 8.3% additional cases compared with screening positive for MDD). Of those with ≥6 month follow-up, 22.9% screened positive for any type of depression (n = 205), 35.6% screened positive for MDD (n = 90), and 42.7% with a positive ASQ result (n = 75) had a depression or self-harm diagnosis or an antidepressant prescription.

Conclusions: Suicide risk screening identifies cases not identified by depression screening. In this study, we underscore opportunities and challenges in primary care related to the high prevalence of depression and suicide risk. Research is needed regarding optimal screening strategies and to help clinicians manage the expected number of screening-identified adolescents.

MeSH terms

  • Adolescent
  • Antidepressive Agents / therapeutic use
  • COVID-19 / epidemiology
  • COVID-19 / psychology
  • Child
  • Depression / diagnosis
  • Depression / drug therapy
  • Depression / epidemiology*
  • Depressive Disorder, Major / diagnosis
  • Depressive Disorder, Major / drug therapy
  • Depressive Disorder, Major / epidemiology
  • Female
  • Humans
  • Loneliness
  • Male
  • Mass Screening / methods*
  • Mental Disorders / diagnosis
  • Mental Disorders / epidemiology
  • Pandemics
  • Primary Health Care / methods*
  • Risk Factors
  • SARS-CoV-2
  • Social Isolation
  • Suicide / statistics & numerical data*
  • Suicide Prevention
  • Young Adult


  • Antidepressive Agents