Longitudinal results of a school-based screening of adolescent students at risk for depression

ObjectivesAdolescent suicide and depression rates have increased rapidly in the past decade. In response, the AAP has called for universal screening in youth ages 12 to 19 years. Schools have been identified as a prime environment for screening. School-based screenings effectively identify youth with depressive symptoms, but few longitudinal studies exist. We present data from multiyear school screenings to monitor adolescent depressive symptoms and treatment utilization over time.MethodsStudents in grades 7, 9, and 11 were screened in 2017 and 2019 for depression and suicidal ideation (SI) as part of a screening program in 2 Boston-area public school districts. Students received the Signs of Suicide curriculum and completed the Patient Health Questionnaire-Adolescent (PHQ-A). Students met with a clinician for a brief assessment if they scored ≥8 on the PHQ-A or reported current SI or past suicide attempt (SA). Treatment utilization data were informally collected. Clinicians debriefed guardians and provided treatment referrals.ResultsIn 2017, 87 (14.7%) seventh graders (56.3% female, 5.8% other gender identity, mean [SD] age 12.8 [1.6] years) and 37 (19.5%) ninth graders (62.2% female, 15.5 [0.6] years) were designated as at-risk (seventh grade: n = 73, PHQ-A ≥8, n = 48 SI, n = 56 past depression, n = 16 past SA; ninth grade: n = 35, PHQ-A ≥8, n = 10 SI, n = 27 past depression, n = 4 past SA). Most students were reported as not in treatment (62.4%; 40.6%) or taking medication (85.6%; 86.5%). Among these at-risk students, 49 seventh graders (57.6%) and 23 ninth graders (62.2%) were screened again in 2019. The mean (SD) PHQ score decreased over time for both the original seventh graders (10.06 [5.08] to 6.51 [6.21]; t = 4.05; p < .001) and the original ninth graders (10.7 [3.3] to 4.9 [4.4]; t = 5.43; p < .001). However, in 2019, 19 of the original seventh graders (38.8%) and 5 of the original ninth graders (21.7%) again reported depressive symptoms or SI. Between screening years, 8 students initiated treatment and/or medication.ConclusionsOur school-based screening program was associated with decreased depressive symptoms over time and may have encouraged families to seek treatment for students who were identified as at-risk. Annual school-based universal screenings have the potential to improve student mental health over the course of adolescence.ADOL, DDD, SC ObjectivesAdolescent suicide and depression rates have increased rapidly in the past decade. In response, the AAP has called for universal screening in youth ages 12 to 19 years. Schools have been identified as a prime environment for screening. School-based screenings effectively identify youth with depressive symptoms, but few longitudinal studies exist. We present data from multiyear school screenings to monitor adolescent depressive symptoms and treatment utilization over time. Adolescent suicide and depression rates have increased rapidly in the past decade. In response, the AAP has called for universal screening in youth ages 12 to 19 years. Schools have been identified as a prime environment for screening. School-based screenings effectively identify youth with depressive symptoms, but few longitudinal studies exist. We present data from multiyear school screenings to monitor adolescent depressive symptoms and treatment utilization over time. MethodsStudents in grades 7, 9, and 11 were screened in 2017 and 2019 for depression and suicidal ideation (SI) as part of a screening program in 2 Boston-area public school districts. Students received the Signs of Suicide curriculum and completed the Patient Health Questionnaire-Adolescent (PHQ-A). Students met with a clinician for a brief assessment if they scored ≥8 on the PHQ-A or reported current SI or past suicide attempt (SA). Treatment utilization data were informally collected. Clinicians debriefed guardians and provided treatment referrals. Students in grades 7, 9, and 11 were screened in 2017 and 2019 for depression and suicidal ideation (SI) as part of a screening program in 2 Boston-area public school districts. Students received the Signs of Suicide curriculum and completed the Patient Health Questionnaire-Adolescent (PHQ-A). Students met with a clinician for a brief assessment if they scored ≥8 on the PHQ-A or reported current SI or past suicide attempt (SA). Treatment utilization data were informally collected. Clinicians debriefed guardians and provided treatment referrals. ResultsIn 2017, 87 (14.7%) seventh graders (56.3% female, 5.8% other gender identity, mean [SD] age 12.8 [1.6] years) and 37 (19.5%) ninth graders (62.2% female, 15.5 [0.6] years) were designated as at-risk (seventh grade: n = 73, PHQ-A ≥8, n = 48 SI, n = 56 past depression, n = 16 past SA; ninth grade: n = 35, PHQ-A ≥8, n = 10 SI, n = 27 past depression, n = 4 past SA). Most students were reported as not in treatment (62.4%; 40.6%) or taking medication (85.6%; 86.5%). Among these at-risk students, 49 seventh graders (57.6%) and 23 ninth graders (62.2%) were screened again in 2019. The mean (SD) PHQ score decreased over time for both the original seventh graders (10.06 [5.08] to 6.51 [6.21]; t = 4.05; p < .001) and the original ninth graders (10.7 [3.3] to 4.9 [4.4]; t = 5.43; p < .001). However, in 2019, 19 of the original seventh graders (38.8%) and 5 of the original ninth graders (21.7%) again reported depressive symptoms or SI. Between screening years, 8 students initiated treatment and/or medication. In 2017, 87 (14.7%) seventh graders (56.3% female, 5.8% other gender identity, mean [SD] age 12.8 [1.6] years) and 37 (19.5%) ninth graders (62.2% female, 15.5 [0.6] years) were designated as at-risk (seventh grade: n = 73, PHQ-A ≥8, n = 48 SI, n = 56 past depression, n = 16 past SA; ninth grade: n = 35, PHQ-A ≥8, n = 10 SI, n = 27 past depression, n = 4 past SA). Most students were reported as not in treatment (62.4%; 40.6%) or taking medication (85.6%; 86.5%). Among these at-risk students, 49 seventh graders (57.6%) and 23 ninth graders (62.2%) were screened again in 2019. The mean (SD) PHQ score decreased over time for both the original seventh graders (10.06 [5.08] to 6.51 [6.21]; t = 4.05; p < .001) and the original ninth graders (10.7 [3.3] to 4.9 [4.4]; t = 5.43; p < .001). However, in 2019, 19 of the original seventh graders (38.8%) and 5 of the original ninth graders (21.7%) again reported depressive symptoms or SI. Between screening years, 8 students initiated treatment and/or medication. ConclusionsOur school-based screening program was associated with decreased depressive symptoms over time and may have encouraged families to seek treatment for students who were identified as at-risk. Annual school-based universal screenings have the potential to improve student mental health over the course of adolescence.ADOL, DDD, SC Our school-based screening program was associated with decreased depressive symptoms over time and may have encouraged families to seek treatment for students who were identified as at-risk. Annual school-based universal screenings have the potential to improve student mental health over the course of adolescence.