Citation

Flaherty LT. Adolesc. Psychiatry (Hilversum) 2020; 10(1): 3-6.

Copyright

(Copyright © 2020, Bentham Science Publishers)

DOI

10.2174/221067661001200413093510

PMID

unavailable

Abstract

Dr. Levin is to be commended for calling attention to the pitfalls of depression screening in his article, Adolescent Depression Screening: Not So Fast. There is no question that untreated depression poses significant risks at all phases of the lifecycle. The CDC has estimated the prevalence of major depressive disorder among adolescents as 8%. Suicide is the second leading cause of death worldwide for youth aged 15 to 24. Suicide rates among adolescents have been rising after falling quite significantly from a peak in the early 1990s. The suicide rate among young teen girls is now nearly triple what it was in 2000 (https://www.businessinsider.com/us-suicide-rate-increased-since-2000-2018-6). Major depressive disorder is the condition most commonly associated with suicide; 19% of adolescents aged 13 to 17.9 years with MDD attempt suicide (Kramer et al., 2012). Universal screening of school populations and patients in primary care settings has been advocated as a way to approach this problem.

Screening has a long history in medicine, particularly in the field of public health, where it has been used to gather epidemiological data. In general medicine, it has been used identify individuals with conditions that might endanger the general public if untreated. For example, screening for tuberculosis is required of individuals working in healthcare facilities. Identifying and treating index cases benefits both individuals and those they might expose to illness. Valid and reliable tests with good sensitivity and specificity for tuberculosis, as well as curative treatments, exist. But is this really the case with depression?

The application of the diagnostic criteria specified in the DSM-III to research on children and adolescents led to the recognition that the same criteria could be applied to this age group (albeit with some modifications). This in turn led to the development of screening instruments such as the Patient Health Questionnaire-9 (PHQ-9), which was modified to develop the PHQ-A for use with adolescents (Johnson et al., 2002).

However, where adolescents are concerned there continues to be some debate about differentiating between normal sadness, transient mood states and depression (Frances, 2013; Miller, 2018). Concerns have been raised that universal screening will result in overdiagnosis, overuse of medication, and, if people who are being treated do not need it, a waste of already scarce resources (Frances, 2013)...

Language: en