P3B300: Early Identification of Pediatric Behavioral Health Concerns: is Screening for Depression Enough?

Background: As pediatric mental health concerns continue to rise in the United States, so does the need for timely identification and intervention.1 In response to this alarming increase, many pediatric practices have started routinely screening adolescent patients for depression and/or self-harm. We currently screen patients attending their primary care visits using the Patient Health Questionnaire (PHQ-9) for depression beginning at age 12. To address growing concerns about patients with anxiety-related symptoms, we began screening 12 year old patients in February 2023. We sought to identify whether the additional screening is beneficial to our patients.

Methods: This cross sectional study compares anxiety screening (Generalized Anxiety Disorder (GAD7)) and depression screening (Patient Health Questionnaire (PHQ9)) results among patients in our large pediatric primary care medical group. PHQ9 and GAD7 results were compared. Paired total score comparisons were made using Wilcoxon Rank Sum Sign Rank Tests and severity classification scores were compared using chi-square tests. Data were analyzed using STATA 16 (College Station, TX).

Results: Preliminary results identified 891 patients for 12 year old well child visit in the first 2 months of the new implementation. Demographic characteristic of the patients are presented below. The median (IQR) scores for the PHQ-9 and GAD7 were each 1 (0,4). 675 patients completed both screening assessments. Of those with both assessments, 20.3% of patients exhibited mild to severe depressive symptoms and 26.4% exhibited mild to severe symptoms of anxiety (p < 0.001). Of the 538 patients who screened negative for depression, 12.6% (n = 68) were identified with mild anxiety, 1.7% (9) with moderate anxiety and 0.9% (5) with severe anxiety. Among those who exhibited mild depressive screening symptoms, 45.2% (n = 42) also screened mild for anxiety, while 8.6% (n = Earl8) screened moderate and 5.4% (n = 5) screened severe for anxiety.

Conclusion: Validated screening measures have become more widely used to identify pediatric adolescent patients at risk for depression and/or self-harm. Screening for depression is likely giving us only a partial picture of what our pediatric patients are experiencing and give clinicians a false sense of security in assessing overall patient health. By screening only for depression, we might have missed the 82 patients exhibiting measurable symptoms of anxiety and no depressive symptoms. Anxiety screening can be completed quickly in the primary care setting and aid pediatricians in making accurate diagnoses for anxious children who present with a wide variety of emotional, behavioral, and physical symptoms. With quick screening workflows in place, clinicians are empowered to identify challenges earlier, provide effective recommendations and appropriate referrals for patients with mental health concerns.