Medical Student Penn State College of Medicine Penn State Health Milton S Hershey Medical Center Hershey, Pennsylvania, United States
Background: Of the 3.5 million adolescents in 2018 with major depressive disorder (MDD) within the prior year, only 41.4% received treatment for depression. Despite the United States Preventive Services Task Force 2016 statement regarding the potential value of adolescent MDD screening in primary care, there is limited data on the degree to which a positive screen results in treatment engagement.
Objective: We evaluated rates of treatment engagement at a pediatric primary care clinic where preventive care visits included MDD screening with the Patient Health Questionnaire Adolescent Version (PHQ-A). We also assessed the impact of demographic variables and provider recommendations on treatment engagement.
Design/Methods: A retrospective chart review of adolescents ages 11-18 seen at the primary care clinic of an academic medical center from July 2017-December 2018 and screened for MDD using the PHQ-A. Demographics included age, race and ethnicity; additional variables included comorbidities, insurance status, score on an anxiety screen and provider recommendations regarding behavioral health care. The primary outcome was MDD treatment engagement within 1 year of a positive PHQ-A, defined as initiation of a psychotropic medication for depression, or a behavioral health treatment session either in the host system (defined by billing codes) or outside (identified by review of provider notes documenting such a service).
Results: Of 1315 adolescents seen for preventive care and screened for MDD, 23.0% had a positive PHQ-A (n=303). Mean age of those screening positive was 13.9 (SD=2.2) years. The majority (59.7%) were female, Non-Hispanic (74.3%), White (61.7%), and 40.6% had Medicaid insurance. Of these individuals, 30.4% (n=92) engaged in treatment. The odds of engaging in treatment was 18% higher for every one-year increase in age (OR= 1.18, 95% CI= [1.05,1.32], p<0.01), and 13% higher for every one-point increase in PHQ-A score (OR=1.13, 95% CI [1.08, 1.20], p <0.01). Among those with a positive PHQ-A, patients whose providers recommended counseling or medication treatment for depression had 6.35 times the odds (95% CI= [1.72, 23.4], p=.006) of engaging in treatment as compared to those who received no documented treatment recommendations (AUC score =.81). Conclusion(s): Only 30% of adolescents with a positive PHQ-A at a large academic pediatric primary care clinic engaged with treatment. The recommendation by a primary care provider to seek care was an impactful intervention that can be targeted to improve engagement with mental health care.
Authors/Institutions: Hannah Cohan, Penn State Health Milton S Hershey Medical Center, Hershey, Pennsylvania, United States; James G. Waxmonsky, Penn State Health Milton S Hershey Medical Center, Hershey, Pennsylvania, United States; Benjamin Fogel, Penn State Health Milton S Hershey Medical Center, Hershey, Pennsylvania, United States; Deepa L. Sekhar, Penn State Health Milton S Hershey Medical Center, Hershey, Pennsylvania, United States
