On Feb. 8, the U.S. Preventive Services Task Force (USPSTF) released its final recommendation statement(www.uspreventiveservicestaskforce.org) and evidence summary(www.uspreventiveservicestaskforce.org) on screening children and adolescents for depression.
The task force issued a "B" recommendation(www.uspreventiveservicestaskforce.org) to screen for major depressive disorder (MDD) in adolescents ages 12 to 18 when adequate systems are in place to ensure accurate diagnosis, effective treatment and appropriate follow-up. However, the group concluded that there was insufficient evidence to assess the balance of benefits and harms of screening for MDD in children age 11 and younger, and called for more research on screening for and treating depression in this age group.
"Primary care clinicians can play an important role in helping to identify adolescents with major depressive disorder and getting them the care they need. Accordingly, the task force recommends that primary care clinicians screen all adolescents between 12 and 18 years old for this condition," said USPSTF member Alex Krist, M.D., M.P.H., in a news release(www.uspreventiveservicestaskforce.org).
The final recommendation statement reaffirms the USPSTF's 2009 recommendation on the topic and its 2015 draft recommendation statement.
- The U.S. Preventive Services Task Force (USPSTF) has issued a final recommendation statement that says adolescents ages 12 to 18 should be screened for major depressive disorder (MDD) when adequate systems are in place for diagnosis, treatment and follow-up.
- However, the USPSTF found that there wasn't enough evidence to assess the benefits and harms of screening for MDD in children age 11 and younger.
- The final recommendation statement reaffirms the USPSTF's 2009 recommendation on the topic and its 2015 draft recommendation statement.
The AAFP agreed with the task force's recommendations in its own recommendations, especially after the group better defined what "adequate systems" meant, Jennifer Frost, M.D., medical director for the AAFP Health of the Public and Science Division, told AAFP News.
Update From Previous Recommendation
In 2009, the USPSTF recommended screening for MDD in adolescents (ages 12 to 18) "when systems are in place to ensure accurate diagnosis, psychotherapy (cognitive-behavioral or interpersonal) and follow-up." The task force concluded that the evidence was insufficient to make a recommendation for children ages 7 to 11.
The current recommendation reaffirms these positions but removes the mention of specific therapies in recognition of more evidence of benefit and decreased concern over the harms of pharmacotherapy in adolescents when they are adequately monitored.
Also, the 2009 recommendation for children specifically addressed children ages 7 to 11, in contrast to the current draft recommendation that pertains to children 11 and younger.
Notes From a Family Physician
Back in September when the draft recommendation statement was released, Frost said screening adolescents for depression is an especially important part of an office visit because parents may not recognize that their child is struggling with depression and may instead view his or her behavior as typical teen angst.
"Adolescents are still developing, and depression can negatively impact this development, affecting their future success and happiness," she said. "Also, adolescents with depression have an increased risk of substance abuse and suicide, as well as a higher risk of depression and other mental disorders when they are adults."
Frost said both of the most popular tools for screening depression, the Patient Health Questionnaire for Adolescents (PHQ-A) and the primary care version of the Beck Depression Inventory (BDI), have relatively good sensitivity and specificity in adolescents.
"I prefer the PHQ-A simply because it is easier to administer," she said. "The BDI is longer and, therefore, takes more time to complete."
Frost also pointed out that if signs of a psychiatric disorder are detected, further evaluation is warranted, regardless of age.
As for treating MDD in adolescents and children, Frost said that decision depends on many variables, including symptoms and their severity, age of the child, child and parent preferences, and what forms of therapy they have access to.
Offering support for a teen or child with depression is critical but can be challenging for families.
"Parents have a range of reactions to their depressed teen, from feeling guilty that they somehow caused the depression to feeling anger towards the teen," Frost said. "I remind them that their teen isn't choosing to be depressed and needs their love and support to recover. They can't be talked out of their depression, so parents should validate their teen's feelings, even if these feelings seem irrational."
Family physicians also should remind parents to watch for signs that their child's depression is getting worse, particularly if the teen is taking antidepressant medication, and notify the child's physician or therapists immediately if they have concerns, she said.
Related AAFP News Coverage
Screen All Adults for Depression, Say USPSTF, AAFP
Evidence Shows Screening in Primary Care Setting Is Beneficial
Rehash of 2001 Study Finds Paroxetine, Imipramine Ineffective, Unsafe for Teens
Results Largely Contradict Original Findings, Raise Transparency Concerns
Fluoxetine, Paroxetine Linked to Increased Birth Defect Risks
Study Didn't Find Similar Risks for Other SSRIs