Evidence is lacking, and the balance of benefits and harms cannot be determined. Edinburgh Postpartum Depression Scale (EPDS) a. Screening should be implemented with adequate systems in place to ensure accurate diagnosis, effective treatment, and appropriate follow-up (B recommendation). Depression can be managed in the primary care or specialist setting or managed collaboratively in both settings. Like other self-report assessments used in children, the CDI is vulnerable to certain limitations. Both the American Academy of Pediatrics and the U.S. Preventive Services Task Force recommends that depression screening be conducted annually. The CDI is a tool that mental health professionals use to measure the cognitive, affective and behavioral signs of depression in children and adolescents between the ages of 7 and 17. Adapted from the Center for Epidemiological Studies Depression Scale for Children (CES-DC). Learn more about depression in children external icon Allgaier AK, Fruhe B, Pietsch K, Saravo B, Baethmann M, Shulte-Korne G. Is the children's depression inventory short version a valid screening tool in pediatric care? “Adequate systems in place” refers to having systems and clinical staff to ensure that patients are screened and, if they screen positive, are appropriately diagnosed and treated with evidence-based care or referred to a setting that can provide the necessary care. Screening for adolescent depression: a comparison of depression scales. A double-blind, randomized, placebo-controlled trial of escitalopram in the treatment of pediatric depression. Recommended Screening. Many different screening tools are available to identify depression in children and adolescents, and some have been used in primary care. The USPSTF concludes with moderate certainty that screening for MDD in adolescents aged 12 to 18 years has a moderate net benefit. Collaborative care for adolescents with depression in primary care: a randomized clinical trial. In addition, a child who receives a positive score on the CDI should be referred for a comprehensive evaluation by a licensed mental health professional. In 2 nationally representative US surveys, ∼8% of adolescents reported having MDD in the past year. To help paediatricians and other child health care providers recognize and diagnose mental health problems, the Canadian Paediatric Society's Mental Health Task Force has compiled a list of screening tools and rating scales for a number of different symptoms and suspected conditions. Little is known about the prevalence of MDD in children. Recommended Screening. Postpartum depression is the most common complication of childbearing. Journal of Nursing Measurement, Volume 25(3), 2017. The FDA has issued a boxed warning for antidepressant agents, recommending that patients of all ages who start antidepressant therapy be monitored appropriately and observed closely for clinical worsening, suicidality, or unusual changes in behavior.1 Collaborative care is a multicomponent, health care system–level intervention that uses care managers to link primary care providers, patients, and mental health specialists. A number of chapters offer, in Started in 1995, this collection now contains 6881 interlinked topic pages divided into a tree of 31 specialty books and 737 chapters. Understanding Your Liebowitz Social Anxiety Scale (LSAS) Results. 5 Depression: Incidence/Prevalence • In 2015, 30% of H.S. The USPSTF found 8 fair- or good-quality RCTs that reported health outcomes in children or adolescents with MDD detected through screening who were treated with SSRIs (4 RCTs), psychotherapy (2 RCTs), SSRIs combined with psychotherapy (1 RCT), or collaborative care (1 RCT). This is not a diagnostic tool. students reported feeling sad or hopeless in the previous 12 months (CDC, 2016) Cognitive-behavioral therapy is one form of therapy that is used to treat anxiety or depression, particularly in older children. This 2012;73(5):369-374. doi:10.1016/j.jpsychores.2012.08.016. You can call Samaritans free on 116 123 if you want to talk to someone now. MDD also increases the risk for suicide. Enter multiple addresses on separate lines or separate them with commas. Four trials reported on suicidality (this analysis included worsening suicidal ideation or a suicide attempt; no completed suicides were reported): 2 with escitalopram, 1 with citalopram, and 1 with fluoxetine. The present recommendation applies to children and adolescents aged ≤18 years who do not have a diagnosis of MDD. The US Preventive Services Task Force (USPSTF) makes recommendations about the effectiveness of specific preventive care services for patients without related signs or symptoms. The Ask Suicide-Screening Questions (ASQ) tool is a brief validated tool for use among both youth and adults. PHQ-9 modified for Adolescents (PHQ-A) Name: Clinician: Date: Instructions: How often have you been bothered by each of the following symptoms during the past two weeks?For each symptom put an “X” in the box beneath the answer that best describes how you have been feeling. Functioning and quality of life in the Treatment for Adolescents with Depression Study (TADS). The 2 BDI studies reported sensitivity ranging from 84% to 90% and specificity ranging from 81% to 86% when a cutoff score of 11 was applied.6,7 One study7 reported a higher area under the curve for male subjects than for female subjects, but neither of the BDI studies reported results according to age or ethnicity. The majority of trials were restricted to adolescents aged 12 to 14 years and older; only 2 of the SSRI trials included children aged 7 or 8 years. These essential functions can be provided through a wide range of arrangements related to clinician types and settings. Four studies recruited adolescents from school settings and compared the screening test with a diagnostic interview or different depression screening test. However, this study was not powered to detect differences. Depressed adolescents have more psychiatric and medical hospitalizations than adolescents who are not depressed. The CES-D as a screen for depression and other psychiatric disorders in adolescents. FINANCIAL DISCLOSURE: The authors have indicated they have no financial relationships relevant to this article to disclose. What are the best screening tools for assessing depression and anxiety in children and adolescents? The short form of the test is generally used as a screening tool, while the long-form is used more often in the diagnosis of depression in children. Hospital Anxiety and Depression Scale (or HADS) – Used for Anxiety & Depression can be used in community as well as hospital. A raw score on the test is essentially meaningless without a professional's interpretation, so parents should always discuss the meaning of the results with the professional who evaluated the child. Adults. The number of items, administrative time to complete screening, and appropriate ages for screening vary. Edinburgh Postpartum Depression Scale (EPDS) a. Approximately 20% of deaths in people with anorexia nervosa are due to suicide. Data and Statistics on Children's Mental Health. Little is known about the prevalence of MDD in children aged ≤11 years. 7 If the PCP believes that an adolescent with a score of 5-9 has symptoms that are Mental Health: Screening Tools and Rating Scales. AHRQ Publication No. Patient Health Questionnaires (PHQs) Although the data are limited, the USPSTF concludes that the evidence on the frequency of medication-related adverse events in adolescents is adequate to estimate that the magnitude of harms of pharmacotherapy is small if patients are closely monitored. The USPSTF found no evidence on the current frequency of or methods used in primary care for screening for MDD in children. The CES-D studies used different diagnostic cutoff scores.7,8 One study enrolled a slightly younger population than the other (range of 11 to 15 years vs average age of >16 years). This question is for testing whether or not you are a human visitor and to prevent automated spam submissions. Members of the USPSTF at the time this recommendation was finalized were as follows: Albert L. Siu, MD, MSPH, Chair (Mount Sinai School of Medicine, New York, and James J. Peters Veterans Affairs Medical Center, Bronx, NY); Kirsten Bibbins-Domingo, PhD, MD, MAS, Co-Vice Chair (University of California, San Francisco, San Francisco, CA); David C. Grossman, MD, MPH, Co-Vice Chair (Group Health Research Institute, Seattle, WA); Linda Ciofu Baumann, PhD, RN, APRN (University of Wisconsin, Madison, WI); Karina W. Davidson, PhD, MASc (Columbia University, New York, NY); Mark Ebell, MD, MS (University of Georgia, Athens, GA); Francisco A.R. The Community Preventive Services Task Force recommends collaborative care for the management of depressive disorders, based on strong evidence of effectiveness in improving depression symptoms, adherence and response to treatment, and remission and recovery from depression. However, the magnitude of harms of pharmacotherapy is small if patients are closely monitored, as recommended by the US Food and Drug Administration (FDA). In a separate recommendation statement, the USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening for suicide risk in primary care settings, including among adolescents (I statement). A number of screening and assessment tools have been validated and are generally available. This is the first study to validate and to compare the Children's Depression Inventory (CDI) and its short version (CDI:S) as screening tools for medically ill children. Block, MD, What You Should Know About Childhood Depression. The CDI has excellent psychometric properties, which means that it measures depression in children accurately and reliably when used properly. • PHQ-9 Modified for • Pediatric Symptom Checklist (PSC-Y) Theodore D. Cosco, PhD University of Oxford, United Kingdom Matthew Prina, Brendon Stubbs, Yu-Tzu Wu. Thank you, {{form.email}}, for signing up. 0 Not True or Hardly Ever True 1 Somewhat True or Sometimes True 2 Very True or Often True 21. Some research indicates, however, that the test is not appropriate for children who have reading difficulties. The information will not be recorded or shared. The USPSTF concludes that MDD screening itself is unlikely to be associated with significant harms, aside from opportunity costs, labeling and potential stigma associated with a positive screening result, and referral for further evaluation and treatment. This self-test is for personal use only. Fluoxetine is approved by the FDA to treat MDD in children aged ≥8 years, and escitalopram is approved to treat MDD in adolescents aged 12 to 17 years. Adolescent Depression Screening and Initial Treatment Toolkit for Primary Care Clinicians Edward Pickens, MD UNC Physicians Network Jill Wright, MD UNC Physicians Network Ty Bristol, MD UNC Department of Pediatrics and UNC Physicians Network Carl Seashore, MD UNC Department of Pediatrics Martha Perry, MD UNC Department of Pediatrics Ashley Nazworth, LCSW UNC Physicians Network … The USPSTF also found adequate evidence that treatment of adolescents identified through screening is associated with beneficial reductions in MDD symptoms. A wide variety of screening tools have been used in the diabetes population in attempts to identify patients with mental health comorbidities. How Is Generalized Anxiety Disorder Diagnosed Using the DSM-5? Depression outcomes were reported after 8 to 12 weeks of SSRI treatment or psychotherapy; the collaborative care study reported outcomes at 52 weeks. Five SSRI trials reported on harms and found no significant differences between intervention groups, although none of the studies was powered to detect these differences. This guideline covers identifying and managing depression in children and young people aged 5 to 18 years. Evidence supports the use of the PHQ-2, PHQ-9, or Edinburgh Postnatal Depression Scale (EPDS; available at https://www.aafp.org/afp/2010/1015/p926.html#afp20101015p926-f1).33 The … Treatment options for MDD in children and adolescents include pharmacotherapy, psychotherapy, collaborative care, psychosocial support interventions, and complementary and alternative medicine approaches. However, the prevalence of depression in primary care settings is often higher in studies with community samples of children and adolescents. As pediatric depression is common but under-detected, routine screening is essential to increase early identification, timely treatment, and symptom monitoring . While depression is often thought of as an adult disorder, the Centers for Disease Control and Prevention (CDC) reports that 4.9% of children between the ages of 6 and 17 have been diagnosed with depression.. Medications for the treatment of depression, such as selective serotonin reuptake inhibitors (SSRIs), have acknowledged harms. How Does the Weschsler Adult Intelligence Scale Measure Intelligence? The BDI takes approximately 10 minutes to complete. E-mail: Copyright © 2016 by the American Academy of Pediatrics. A draft version of this recommendation statement was posted for public comment on the USPSTF Web site from September 8, 2015, to October 5, 2015. The Children's Depression Inventory (CDI), Ⓒ 2021 About, Inc. (Dotdash) — All rights reserved, Verywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Therefore, the test's author recommends retesting any child who receives a positive score on the CDI two to four weeks after the initial test. This factor underscores the importance of additional research in child and adolescent populations that are similar to populations found in primary care settings; the goal is to study the effects of comorbid conditions on screening accuracy, type of MDD treatment selected, and benefits and harms. The CRAFFT acronym comes from key words in each of the six questions developed to screen adolescents for high risk alcohol and other drug use disorders simultaneously. An accurate diagnosis can only be made through clinical evaluation. METHODS: The USPSTF reviewed the evidence on the benefits and harms of screening, accuracy of primary care–feasible screening tests, and benefits and harms of treatment with psychotherapy, medications, and collaborative care models in patients aged 7 to 18 years. Health Care Into Pediatric Practice, and Chapter2, Pediatric Care of Children and AdolescentsWith Mental Health Problems. The USPSTF found no studies that directly evaluated whether screening for MDD in children aged ≤11 years in primary care (or comparable) settings leads to improved health and other outcomes, and found inadequate evidence on the benefits of treatment in children detected through screening. Depression Screening Tools. The symptoms of depression are commonly mistaken for ADHD, and vice versa, because the markers of both conditions can overlap. The Beck Depression Inventory: psychometric characteristics and usefulness in nonclinical adolescents. Research has also shown that the CDI (both the full version and short version) is a valid instrument when used for screening for depression in pediatric settings. However, doctors working in pediatric care are advised to follow up with diagnostic assessments to rule out potential false positives. Only a professional trained on the properties of the CDI can accurately interpret the results. Get our free guide when you sign up for our newsletter. Clinical Assessment of Child and Adolescent Personality and Behavior. The USPSTF recommends screening for major depressive disorder (MDD) in adolescents aged 12 to 18 years. from the PHQ-9 that is used for adults. Journal of Nervous Mental Disorders 168(12):736–740. The US Congress mandates that the Agency for Healthcare Research and Quality support the operations of the US Preventive Services Task Force. The USPSTF found adequate evidence that screening instruments for depression can accurately identify MDD in adolescents aged 12 to 18 years in primary care settings. 13-05192-EF-1, Agency for Healthcare Research and Quality. Although it is normal for children and adolescents to experience occasional feelings of sadness and other symptoms of depression, children and adolescents with MDD experience 1 or more major depressive episodes, lasting at least 2 weeks, that cause significant functional impairment across social, occupational, or educational domains. Trial outcomes included treatment response, which was defined differently across studies; symptom severity; and global functioning. 2 The 10-question Edinburgh Postnatal Depression Scale (EPDS) is a valuable and effici ent way of identifying patients at risk for “perinatal” depression. Pediatrics, November 1, 2010.. Screening should be implemented with adequate systems in place to ensure accurate diagnosis, effective treatment, and appropriate follow-up (B recommendation). Each response to an item is scored as follows: 0 = “Not At All” 1 = “A Little” 2 = “Some” 3 = “A Lot” However, items 4, 8, 12, and 16 are phrased positively, … As a result, the USPSTF concludes that the evidence is insufficient to make a recommendation regarding screening for MDD in children aged 7 to 11 years. In some children and adolescents with MDD, these symptoms may present as periods of disruptive mood and irritability rather than as a sad mood and may last for weeks, months, or even years. FPnotebook.com is a rapid access, point-of-care medical reference for primary care and emergency clinicians. The mean age of onset of MDD is ∼14 to 15 years. The number of items, administrative time to complete screening, and appropriate ages for screening vary. The STAR Center resources focus on early childhood screening. If you’re 16 or over, this mood self-assessment can help you better understand how you've been feeling recently. Ten percent of children aged 5 to 12.9 years and 19% of adolescents aged 13 to 17.9 years with MDD attempt suicide.2, The mean age of onset of MDD in childhood and adolescence is ∼14 to 15 years, and onset is earlier in girls than in boys. The USPSTF concludes that the evidence on screening for MDD in children aged ≤11 years is insufficient. The patient health questionnaire for adolescents: validation of an instrument for the assessment of mental disorders among adolescent primary care patients. The single trial of collaborative care found no differences in the number of psychiatric hospitalizations between the intervention and control groups (6% vs 4%).17 More patients in the control group experienced an emergency department visit with a primary psychiatric diagnosis than in the intervention group (10% vs 2%). For example, because children don't have the same sophistication as adults related to understanding and reporting their emotions, their responses may not reflect their true emotional state. MDD is associated with significant morbidity and mortality. Remission and residual symptoms after short-term treatment in the Treatment of Adolescents with Depression Study (TADS). The number of items, administrative time to complete screening, and appropriate ages for screening vary. Important . Screening of a general childhood population for depressive symptoms may involve the use of questionnaires such as the Pediatric Symptom Checklist by the parents and caregivers of children … Center for Epidemiological Studies Depression Scale for Children (CES-DC) Edinburgh Postnatal Depression Scale (EPDS) Geriatric Depression Scale (GDS) Hamilton Rating Scale for Depression (HAM-D) Hospital Anxiety and Depression Scale; Kutcher Adolescent Depression Scale (KADS) Major Depression Inventory (MDI) Montgomery-Åsberg Depression Rating Scale (MADRS) PHQ-9; Mood and … appropriately-used as a screening tool, not a tool for making a firm diagnosis; clinical validation by the primary care provider (PCP) is necessary to confirmation a diagnosis of major depression. Evaluation of the Patient Health Questionnaire-9 Item for Detecting Major Depression Among Adolescents. The BDI can be used for ages 13 to 80. The study did not report other outcomes or stratify results according to age, race, or ethnicity. A sample of 406 pediatric hospital patients, aged 9 to 12 years (56.2% male, 77.1% inpatients), completed the German CDI. They should not be construed as an official position of the Agency for Healthcare Research and Quality or the US Department of Health and Human Services. In instances in which treatment is recommended, treatment can be initiated by the screening provider or through referral to another set of treatment providers. Children and adolescents with MDD more often have comorbid conditions than children and adolescents without MDD, particularly in primary care settings. It would be helpful to quantify the proportion of screen-detected subjects who are treated or referred, as well as their willingness and ability to obtain assessment and treatment. 2 The 10-question Edinburgh Postnatal Depression Scale (EPDS) is a valuable and effici ent way of identifying patients at risk for “perinatal” depression. For rare events, meta-analyses are needed that include only children and adolescents with MDD and focus on current FDA-approved medications. Important Information: Diagnostic criteria for a major depressive episode are slightly different for adults and children or adolescents in the DSM-IV-TR. These include the Patient Health Questionnaire-9 (4,7), the Children’s Depression Inventory (1), Beck’s Depression Inventory (5), and the Screen for Childhood Anxiety Related Emotional Disorders (5). The Joint Commission approves the use of the ASQ for all ages. The USPSTF found inadequate evidence that screening tests can accurately identify MDD in children and inadequate evidence on the effectiveness of treatment of children identified through screening. Based on the stepped-care model, it aims to improve recognition and assessment and promote effective treatments for mild and moderate to severe depression. The Screening Tool Finder is not exhaustive, and other screening tools may be available. It can also be used as an instrument to monitor changes in depression symptoms over time. Gundersen Health System Family Medicine Residency, La Crosse, WI. Fluoxetine, cognitive-behavioral therapy, and their combination for adolescents with depression: Treatment for Adolescents With Depression Study (TADS) randomized controlled trial. It also discriminates between ma… Similarly, the USPSTF notes that policy and coverage decisions involve considerations in addition to the evidence of clinical benefits and harms. A number of comments focused on the phrase “adequate systems.” Some commenters requested a more detailed definition of what constitutes an “adequate system” for screening, others recommended removing the conditional term “when,” and others recommended that the requirement for adequate systems be stronger. 116. You should discuss follow-up assessments with your child's doctor to determine the best course of treatment for your child. Methods.