Major depressive disorder (MDD) is a serious form of depression that, when it strikes adolescents, can make it difficult for them to function, relate and develop. That difficulty, in turn, can affect their performance at school or work and their interactions with family and peers.
Research has also shown(ccp.sagepub.com) that MDD increases the risk for suicide in younger patients: 19 percent of adolescents ages 13-17.9 years and 10 percent of children ages 5-12.9 years with the diagnosis attempt suicide. And although treatment is critical for patients with MDD, only 36 percent to 44 percent of children and adolescents with depression receive treatment, suggesting that the majority of depressed youth are undiagnosed and untreated.
After investigating whether screening for depression in the primary care setting can help identify adolescents with MDD and allow physicians to facilitate appropriate support and treatment to alleviate symptoms and lessen patients' risk of suicide, the U.S. Preventive Services Task Force (USPSTF) issued a draft recommendation statement(www.uspreventiveservicestaskforce.org) on the topic. In that Sept. 8 statement, task force members said that adolescents ages 12 to 18 should be screened for MDD "when adequate systems are in place for diagnosis, treatment and monitoring."
"Major depressive disorder can be a debilitating condition for adolescents and their families," USPSTF member Alex Kemper, M.D., M.P.H., M.S., said in an accompanying news release.(www.uspreventiveservicestaskforce.org) "Screening in a primary care setting can help to identify youth with depression who might not otherwise be identified."
- The U.S. Preventive Services Task Force (USPSTF) has issued a draft 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 monitoring.
- However, the USPSTF found that there wasn't enough evidence to assess the benefits and harms of screening for MDD in children 11 and younger.
- The USPSTF will accept comments on the draft recommendation and its accompanying draft evidence review through Oct. 5.
The evidence review(www.uspreventiveservicestaskforce.org) on which the task force based its B recommendation(www.uspreventiveservicestaskforce.org) found that adolescents ages 12 to 18 who were screened in a primary care setting and identified as having MDD, and who subsequently received treatment for the condition, experienced improved depression symptoms and daily functioning.
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.
"We are calling for more research into whether screening children younger than 12 would result in the same benefits," said task force member Alex Krist, M.D., M.P.H., in the release.
Update from 2009 Recommendations
Jennifer Frost, M.D., medical director for the AAFP Health of the Public and Science Division, told AAFP News that the new USPSTF draft recommendations update very similar recommendations(www.uspreventiveservicestaskforce.org) the task force released in 2009. The AAFP mirrored those statements in its own recommendations at the time.
In 2009, the recommendation for adolescents said to screen those ages 12-18 for MDD when "systems are in place to ensure accurate diagnosis, psychotherapy (cognitive-behavioral or interpersonal) and follow-up."
The 2009 recommendation for children said that evidence was insufficient to assess the balance of benefits and harms for screening in this patient group, but it specifically addressed children ages 7-11, in contrast to the current draft recommendation that pertains to children 11 and younger.
Family Physician Weighs In
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.
The USPSTF will accept comments on the draft recommendation statement(www.uspreventiveservicestaskforce.org) and its accompanying draft evidence review(www.uspreventiveservicestaskforce.org) through Oct. 5.
The AAFP is reviewing the USPSTF's draft recommendations and will update its own recommendations after the task force publishes its final recommendation statement.
Related AAFP News Coverage
USPSTF Proposes Screening All Adults for Depression
Clinical Support Systems Should Be in Place, Says Task Force