Quality of Care in Adolescent Depression

12% of adolescents are diagnosed with depression. Depression is a chronic condition that impairs functioning and causes long-term outcomes to decline. Suicide is also a serious problem in this age group, because 8% of the adolescents with depression commit suicide. Depression can be treated with medications and therapy; however, up to 80% of adolescents that need help managing their depression do not receive quality care. This study seeks to determine how follow up care for adolescents with depression should be conducted, since there is a gap between initial treatment and follow-up visits.

The study was conducted with 4612 patients with an average age around 16 years old. 66% of these participants were females. It was a retrospective study from electronic health records. The data was collected from an initial date and then to three months later to determine if any follow-up visits occurred.

The results were that 68% of adolescents diagnosed with depression did not have a follow up symptom assessment and 19% did not receive any follow-up care. 40% of adolescents that were prescribed antidepressants didn’t have a follow-up documented for three months later in their original work-up. All the different health care sites also had completely different rates of going about their follow-ups if they were conducted.

I feel that this condition should definitely have follow up visits, especially when it is presented in adolescents. Follow-ups for drug related therapies are extremely important, because it is often hard to find the right dose and type of antidepressant that works well for the patient. Teenagers are also at a higher risk of suicide due to antidepressants, so they need to be watched closely. A better system that is universal should be implemented for adolescent depression. They should receive high quality of care, and they should be able to have this care universally. What are some ways we can spread awareness of depression in adolescents?

O’Connor BC, Lewandowski R, Rodriguez S, et al. Usual Care for Adolescent Depression From Symptom Identification Through Treatment Initiation. JAMA Pediatr. Published online February 01, 2016. doi:10.1001/jamapediatrics.2015.4158.

USPSTF Recommendation for Screening for Depression in Adults

The USPSTF has updated its recommendation from 2009 on screening adults for depression. The USPSTF is the US Preventive Services Task Force. The recommendation applies to the population over the age of 18 and is for the general population. The update in the recommendation is that there is specific mention of screening of pregnant and postpartum women unlike the 2009 recommendation in which that sub group was not mentioned. The 2009 recommendation also suggested selective screening based on professional judgment and patient preference or when staff-assisted depression care supports are in place. This is omitted in the new recommendation, claiming that the screening no longer needs to be selective, but all inclusive.

Besides suggesting that the general adult population and postpartum women be screened, the recommendation suggests that “screening should be implemented with adequate systems in place to ensure accurate diagnosis, effective treatment, and appropriate follow-up.” This a category B recommendation, meaning that it is recommended to offer or provide service and that there is high certainty that the net benefit is moderate.

Depression is the lead cause in disability in those over the age of 15, and with postpartum women, depression can be harmful not only to the woman, but also to the child. Creating effective screening and treatment for depression can have large impacts on health.

The USPSTF acknowledges that they do not consider the cost when making recommendations. How would the cost of screening and treatment of depression that is suggested affect the implementation of this recommendation? In addition, would these costs actually be lower than the costs of untreated depression?

Siu, AL. Screening for Depression in Adults US Preventive Services Task Force Recommendation Statement. JAMA. 2016;315(4):380-387. doi:10.1001/jama.2015.18392.