Adolescent Depression Screening: Not So Fast

Author(s): Edmund C. Levin*

Journal Name: Adolescent Psychiatry

Volume 10 , Issue 1 , 2020

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Abstract:

Background: Screening adolescents for depression has recently been advocated by two major national organizations. However, this practice is not without controversy.

Objective: To review diagnostic, clinical, and conflict of interest issues associated with the calls for routine depression screening in adolescents.

Methods: The evaluation of depression screening by the US Preventive Services Task Force is compared and contrasted with those of comparable agencies in the UK and Canada, and articles arguing for and against screening are reviewed. Internal pharmaceutical industry documents declassified through litigation are examined for conflicts of interest. A case is presented that illustrates the substantial diagnostic limitations of self-administered mental health screening tools.

Discussion: The value of screening adolescents for psychiatric illness is questionable, as is the validity of the screening tools that have been developed for this purpose. Furthermore, many of those advocating depression screening are key opinion leaders, who are in effect acting as third-party advocates for the pharmaceutical industry. The evidence suggests that a commitment to marketing rather than to science is behind their recommendations, although their conflicts of interest are hidden in what seem to be impartial third-party recommendations.

Keywords: Adolescent depression, Beck youth depression inventory, depression screening, key opinion leaders, pharmaceutical marketing, PHQ.

Amsterdam, J.D., McHenry, L.B., Jureidini, J.N. (2017). Industry-corrupted psychiatric trials. Psychiatr. Pol., 51(6), 993-1008.
[http://dx.doi.org/10.12740/PP/80136] [PMID: 29432499]
Beck, A.J., Singer, P.M., Buche, J., Manderscheid, R.W., Buerhaus, P. (2018). Improving data for behavioral health workforce planning: Development of a minimum data set. Am. J. Prev. Med., 54(6) (Suppl. 3), S192-S198.
[http://dx.doi.org/10.1016/j.amepre.2018.01.035] [PMID: 29779542]
Bergus, G.R., Hartz, A.J., Noyes, R., Jr, Ward, M.M., James, P.A., Vaughn, T., Kelley, P.L., Sinift, S.D., Bentler, S., Tilman, E. (2005). The limited effect of screening for depressive symptoms with the PHQ-9 in rural family practices. J. Rural Health, 21(4), 303-309.
[http://dx.doi.org/10.1111/j.1748-0361.2005.tb00099.x] [PMID: 16294652]
Dowdy, E., Ritchey, K., Kamphaus, R.W. (2010). School-based screening: A population-based approach to inform and monitor children’s mental health needs. School Ment. Health, 2(4), 166-176.
[http://dx.doi.org/10.1007/s12310-010-9036-3] [PMID: 21088687]
Frances, A. (2016). Should all teens be screened for depression? Wall Street Journal.April 10; Retrieved from https://www.wsj.com/articles/should-all-teens-be-screened-for-depression-1460340172
Ham, P., Allen, C. (2012). Adolescent health screening and counseling. Am. Fam. Physician, 86(12), 1109-1116.
[PMID: 23316983]
Hoeper, E.W., Nycz, G.R., Kessler, L.G., Burke, J.D., Jr, Pierce, W.E. 1(984). The usefulness of screening for mental illness. Lancet, 7, 33-35.
Hoffman, L. (2018). A proposal to address the workforce shortage in child and adolescent psychiatry. J. Am. Acad. Child Adolesc. Psychiatry, 57(12), 977-978.
[http://dx.doi.org/10.1016/j.jaac.2018.06.027] [PMID: 30522744]
Jha, M.K., Rush, A.J., Trivedi, M.H. (2018). When discontinuing SSRI antidepressants is a challenge: Management tips. Am. J. Psychiatry, 175(12), 1176-1184.
[http://dx.doi.org/10.1176/appi.ajp.2018.18060692] [PMID: 30501420]
Jerant, A., Kravitz, R.L., Fernandez Y Garcia, E., Feldman, M.D., Cipri, C., Nishio, D., Knoepfler, A., Wooddell, M.K., Baquero, V., Franks, P. (2014). Potential antidepressant overtreatment associated with office use of brief depression symptom measures. J. Am. Board Fam. Med., 27(5), 611-620.
[http://dx.doi.org/10.3122/jabfm.2014.05.140038] [PMID: 25201931]
Jureidini, J. (2012). Key opinion leaders in psychiatry: a conflicted pathway to career advancement. Aust. N. Z. J. Psychiatry, 46(6), 495-497.
[http://dx.doi.org/10.1177/0004867412446494] [PMID: 22679201]
Jureidini, J.N., Amsterdam, J.D., McHenry, L.B. (2016). The citalopram CIT-MD-18 pediatric depression trial: Deconstruction of medical ghostwriting, data mischaracterisation and academic malfeasance. Int. J. Risk Saf. Med., 28(1), 33-43.
[http://dx.doi.org/10.3233/JRS-160671] [PMID: 27176755]
Kroenke, K., Spitzer, R.L. (2002). The PHQ-9: A new depression diagnostic and severity measure. Psychiatr. Ann., 32, 509-521.
[http://dx.doi.org/10.3928/0048-5713-20020901-06]
Le Noury, J., Nardo, J.M., Healy, D., Jureidini, J., Raven, M., Tufanaru, C., Abi-Jaoude, E. (2015). Restoring Study 329: efficacy and harms of paroxetine and imipramine in treatment of major depression in adolescence. BMJ, 351(351), h4320.
[http://dx.doi.org/10.1136/bmj.h4320] [PMID: 26376805]
Lyon, A.R., Maras, M.A., Pate, C.M., Igusa, T., Vander Stoep, A. (2016). Modeling the impact of school-based universal depression screening on additional service capacity needs: A system dynamics approach. Adm. Policy Ment. Health, 43(2), 168-188.
[http://dx.doi.org/10.1007/s10488-015-0628-y] [PMID: 25601192]
McCormick, E., Thompson, K., Stoep, A.V., McCauley, E. (2009). The case for school-based depression screening: Evidence from established programs. Rep. Emot. Behav. Disord. Youth, 9(4), 91-96.
[PMID: 26451134]
Meffert, J.J. (2009). Key opinion leaders: where they come from and how that affects the drugs you prescribe. Dermatol. Ther., 22(3), 262-268.
[http://dx.doi.org/10.1111/j.1529-8019.2009.01240.x] [PMID: 19453351]
Miller, D. (2018). Universal depression screening for adolescents not without controversy. Fam. Pract. News, 11(May)https://www.mdedge.com/familypracticenews/article/165468/depression/universal-depression-screening-adolescents-not-without
Mitchell, A.J., Yadegarfar, M., Gill, J., Stubbs, B. (2016). Case finding and screening clinical utility of the Patient Health Questionnaire (PHQ-9 and PHQ-2) for depression in primary care: a diagnostic meta-analysis of 40 studies. BJPsych Open, 2(2), 127-138.
[http://dx.doi.org/10.1192/bjpo.bp.115.001685] [PMID: 27703765]
Parry, P.I., Levin, E.C. (2012). Pediatric bipolar disorder in an era of “mindless psychiatry”. J. Trauma Dissociation, 13(1), 51-68.
[http://dx.doi.org/10.1080/15299732.2011.597826] [PMID: 22211441]
Pfizer. Pfizer Inc. to offer free public access to mental health assessment tools to improve diagnosis and patient care. Press Release. Retrieved from: https://www.pfizer.com/news/press-release/press-release-detail/pfizer_to_offer_free_public_access_to_mental_he alth_assessment_tools_to_improve_diagnosis_and_pa tient_care
Prochaska, J.D., Le, V.D., Baillargeon, J., Temple, J.R. (2016). Utilization of professional mental health services related to population-level screening for anxiety, depression, and post-traumatic stress disorder among public high school students. Community Ment. Health J., 52(6), 691-700.
[http://dx.doi.org/10.1007/s10597-015-9968-z] [PMID: 26733335]
Richardson, L.P., McCauley, E., Grossman, D.C., McCarty, C.A., Richards, J., Russo, J.E., Rockhill, C., Katon, W. (2010). Evaluation of the Patient Health Questionnaire-9 Item for detecting major depression among adolescents. Pediatrics, 126(6), 1117-1123.
[http://dx.doi.org/10.1542/peds.2010-0852] [PMID: 21041282]
Roseman, M., Kloda, L.A., Saadat, N., Riehm, K.E., Ickowicz, A., Baltzer, F., Katz, L.Y., Patten, S.B., Rousseau, C., Thombs, B.D. (2016). Accuracy of depression screening tools to detect major depression in children and adolescents: A systematic review. Can. J. Psychiatry, 61(12), 746-757.
[http://dx.doi.org/10.1177/0706743716651833] [PMID: 27310247]
Smith, C., Erford, B.T. (2001). Test review: Beck Depression Inventory – II.. Alexandria, VA: Association for Assessment in Counselling and Education. Retrieved from: http://aac.ncat.edu/newsnotes/y98fall.html
Thombs, B.D., Saadat, N., Riehm, K.E., Karter, J.M., Vaswani, A., Andrews, B.K., Simons, P., Cosgrove, L. (2017). Consistency and sources of divergence in recommendations on screening with questionnaires for presently experienced health problems or symptoms: a comparison of recommendations from the Canadian Task Force on Preventive Health Care, UK National Screening Committee, and US Preventive Services Task Force. BMC Med., 15(1), 150.
[http://dx.doi.org/10.1186/s12916-017-0903-8] [PMID: 28789659]
Thombs, B.D., Ziegelstein, R.C. (2017). Primary care doctors should not screen their patients for depression. Expert Rev. Neurother., 17(7), 645-647.
[http://dx.doi.org/10.1080/14737175.2017.1327356] [PMID: 28471250]
US Preventive Services Task Force Grade definitions. Retrieved from: https: //www.uspreventiveservicestaskforce.org/Page/Name/grade-definitions
US Preventive Services Task Force. (2018). About the USPSTF. Retrieved from: https: //www.uspreventiveservicestaskforce.org/Page/Name/about-the-uspstf
Wagner, K.D. (2018). President’s address: Depression awareness and screening in children and adolescents. J. Am. Acad. Child Adolesc. Psychiatry, 57(1), 6-7.
[http://dx.doi.org/10.1016/j.jaac.2017.10.015]
Weist, M.D., Rubin, M., Moore, E., Adelsheim, S., Wrobel, G. (2007). Mental health screening in schools. J. Sch. Health, 77(2), 53-58.
[http://dx.doi.org/10.1111/j.1746-1561.2007.00167.x] [PMID: 17222155]
Zuckerbrot, R.A., Cheung, A., Jensen, P.S., Stein, R.E.K., Laraque, D., Laraque, D. GLAD-PC STEERING GROUP. (2018). Guidelines for adolescent depression in primary care (GLAD-PC): Part I. Practice preparation, identification, assessment, and initial management. Pediatrics, 141(3), e20174081.
[http://dx.doi.org/10.1542/peds.2017-4081] [PMID: 29483200]


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Article Details

VOLUME: 10
ISSUE: 1
Year: 2020
Page: [59 - 69]
Pages: 11
DOI: 10.2174/2210676609666190617145102

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