Depression in Primary Care Toolkit (in multiple languages). The number of items, administrative time to complete screening, and appropriate ages for screening vary. No studies found significant differences, although none of the studies was sufficiently powered for this outcome. Some research indicates, however, that the test is not appropriate for children who have reading difficulties. If your child has been diagnosed with depression or will be evaluated for depression, you may have heard of the Children's Depression Inventory (CDI). Pediatric Symptom Checklist (PSC) Penn State Worry Questionnaire for Children (PSWQ-C) Revised Child Anxiety Depression Scale (RCADS) Spence Children's Anxiety Scale (SCAS) Strengths and Difficulties Questionnaire (SDQ) Student Risk Screening Scale (SRSS) Vanderbilt ADHD Diagnostic Rating Scale; Multidimensional Anxiety Scale for Children (MASC 2) This guideline includes new and updated recommendations on: … Screening should be implemented with adequate systems in place to ensure accurate diagnosis, effective treatment, and appropriate follow-up (B recommendation). dementia, delirium or children. 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. The Depression Self-Rating Scale for Children was developed in 1978 as part of a Masters of Philosophy Thesis at the University of Edinburgh. One trial examined the efficacy of escitalopram according to age group (children versus adolescents) and found that escitalopram was superior to placebo in improving depression symptoms, depression symptom severity, and global functioning in adolescents but not in children.13 No trials examined efficacy across gender or race/ethnicity subgroups. If providers choose, they can “pre - screen” with PHQ-2 to determine if a longer standardized screening tool is needed. The USPSTF found adequate evidence on the harms of psychotherapy and psychosocial support in adolescents and estimates that the magnitude of these harms is small to none. You should discuss follow-up assessments with your child's doctor to determine the best course of treatment for your child. The USPSTF found no studies of screening instruments for depression in children aged ≤11 years in primary care (or comparable) settings and concludes that the evidence is inadequate. Treatment for Adolescents With Depression Study (TADS) Team. 4 Depression. Journal of Nursing Measurement, Volume 25(3), 2017. You will be redirected to aap.org to login or to create your account. Screening negative on a screening test, however, does not always preclude referral when clinical judgment or parental concerns suggest otherwise. 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. The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening for MDD in children aged ≤11 years (I statement). • PHQ-9 Modified for • Pediatric Symptom Checklist (PSC-Y) Reliability and Validity of the Center for Epidemiologic Studies Depression Scale in a Population-Based Cohort of Middle-Aged U.S. 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. This guideline covers identifying and managing depression in children and young people aged 5 to 18 years. Like other self-report assessments used in children, the CDI is vulnerable to certain limitations. Two of the most often studied instruments are the Patient Health Questionnaire for Adolescents (PHQ-A) and the primary care version of the Beck Depression Inventory (BDI). The inventory contains 21 self-report items which individuals complete using multiple choice response formats. Results according to gender were inconsistent, and neither study stratified results according to age or ethnicity. POPULATION: This recommendation applies to children and adolescents aged ≤18 years who do not have an MDD diagnosis. The CDI is a self-report assessment written at a first-grade reading level, which means that your child will be given the paper and pencil assessment to complete by themselves. 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.. Methods. Center for Epidemiological Studies Depression Scale for Children (CES-DC) The Center for Epidemiological Studies Depression Scale for Children (CES-DC) is a 20-item self-report depression inventory with possible scores ranging from 0 to 60. Questions focus on feelings over the past week and the tool … 1 Month 2 Month 4 Month 6 Month. Data and Statistics on Children's Mental Health. Two studies evaluated the benefits of cognitive behavioral therapy (CBT) compared with placebo (waitlist control or clinical monitoring) in adolescents with MDD and reported nonsignificant improvements in response (43.2% vs 34.8%) or recovery (odds ratio [OR], 2.15 [95% confidence interval (CI), 0.87–5.33]).10,11,16 Results for remission (16% vs 17%) were not significantly different between the CBT and placebo groups. The causes of MDD are not fully known and likely involve a combination of genetic, biologic, and environmental factors. The EPDS is easy to administer and has proven to be an effective screening tool. Journal of Psychosomatic Research. Maternal Depression . If you are concerned that your child may be struggling with depression, you might consider filling out the Center for Epidemiological Studies Depression Scale for Children (CES-DC). The Ask Suicide-Screening Questions (ASQ) tool is a brief validated tool for use among both youth and adults. For treatment of MDD, research needs include well-designed studies of psychotherapy and combined treatments, as well as studies of the benefits and harms of other treatments (eg, non-SSRI medications, complementary/alternative modalities). Data on the accuracy of MDD screening instruments in younger children are limited. Reviewers collected patient demographics, indicated any depression screening and screening with a validated tool (PHQ-2/PHQ-9), and recorded initial plans of care (follow-up with primary care practitioner, referral to mental health professional, or depression already being addressed) for the eligible population. The mean age of onset of MDD is ∼14 to 15 years. 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. If your child has been diagnosed with depression or will be evaluated for depression, you may have heard of the Children's Depression Inventory (CDI). Screen yourself or a family member for an anxiety disorder, depression, OCD, PTSD, or a phobia. Only 36% to 44% of children and adolescents with depression receive treatment, suggesting that the majority of depressed youth are undiagnosed and untreated.3. Aron Janssen, MD is board certified in child, adolescent, and adult psychiatry and is the vice chair of child and adolescent psychiatry Northwestern University. The USPSTF found no direct evidence on the harms of screening for MDD in adolescents. Recommended Screening. The systematic review had eligibility requirements that excluded studies with subjects who had comorbid disorders. Depression can also negatively affect the developmental trajectories of affected youth. If you have concerns about possible depression see a mental health professional. Tool for Families: Common Signs of Depression in Children and Adolescents, p. 147. MDD is associated with significant morbidity and mortality. The USPSTF concludes that the evidence on screening for MDD in children aged ≤11 years is insufficient. The Beck Depression Inventory: psychometric characteristics and usefulness in nonclinical adolescents. How Is Generalized Anxiety Disorder Diagnosed Using the DSM-5? Objective: 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. 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). Edinburgh Postpartum Depression Scale (EPDS) a. The USPSTF recommends screening for major depressive disorder (MDD) in adolescents aged 12 to 18 years. Screening for Depression in Children and Adolescents: Clinical Summary. Sensitivity ranged from 18% to 84% and specificity ranged from 38% to 83%, depending on the cutoff score used. Recognising and responding to adolescent depression in general practice: developing and implementing the Therapeutic Identification of Depression in Young people (TIDY) programme. No studies examined subgroup differences in harms. 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. A positive result on an initial screening test does not necessarily indicate the need for treatment. Children’s symptom and social functioning self-report scales: Comparison of mothers’ and children’s reports. The CRAFFT is a behavioral health screening tool for use with children and adolescents through age 20 years. NOTE: We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail. However, this study was not powered to detect differences. This What are the best screening tools for assessing depression and anxiety in children and adolescents? Collaborative care for adolescents with depression in primary care: a randomized clinical trial. The CES-D as a screen for depression and other psychiatric disorders in adolescents. [published online ahead of print February 9, 2016]. However, risk for rare events could not be precisely determined because the studies had limited statistical power. One study evaluated the BDI, 1 study evaluated the Center for Epidemiologic Studies Depression Scale (CES-D), 1 study evaluated the BDI and the CES-D, and 1 study evaluated the Clinical Interview Schedule–Revised. This question is for testing whether or not you are a human visitor and to prevent automated spam submissions. Therefore, the target population for the tools is children aged 0 to 5 years. For rare events, meta-analyses are needed that include only children and adolescents with MDD and focus on current FDA-approved medications. Each item in the CDI has three statements, and the child is asked to select the one answer that best describes their feelings over the past two weeks. Little is known about the prevalence of MDD in children. A requirement for effective screening is a screening tool with demonstrated high accuracy. Other self-report assessments for identifying depression in children include the Beck Depression Inventory (BDI) and the Weinberg Screening Affective Scale (WSAS). Updated April 19, 2019. 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. Adapted from the Center for Epidemiological Studies Depression Scale for Children (CES-DC). 7 The HEADS mnemonic has different variations, such as the HEADDS or HEEADSSS, but with commonality among all of them. The USPSTF recognizes that clinical decisions involve more considerations than evidence alone. 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 … Theodore D. Cosco, PhD University of Oxford, United Kingdom Matthew Prina, Brendon Stubbs, Yu-Tzu Wu. A new screening tool based on the previously developed mnemonic designed to assist physicians with obtaining a psychosocial history from adolescents as part of a routine visit was developed by researchers at the Children’s Hospital of Eastern Ontario. When other outcomes, such as symptom severity or global functioning, were reported, they also favored the SSRI group. Block, MD, What You Should Know About Childhood Depression. 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, … Health Care Into Pediatric Practice, and Chapter2, Pediatric Care of Children and AdolescentsWith Mental Health Problems. What Are the Signs That You Are Severely Depressed? In 2009, the USPSTF recommended screening for MDD in adolescents (aged 12–18 years) when systems are in place to ensure accurate diagnosis, psychotherapy (CBT or interpersonal), and follow-up, and concluded that the evidence was insufficient to make a recommendation regarding children (aged 7–11 years). A number of chapters offer, in The present recommendation applies to children and adolescents aged ≤18 years who do not have a diagnosis of MDD. The CDI has two forms: The original 27-item version, and the 10-item short-form version, which takes between 5 and 15 minutes for the child to complete. The USPSTF found inadequate evidence regarding the harms of screening for MDD in children. A comparison to its full-length, Anhedonia (inability or decreased ability to experience joy), Ineffectiveness (lack of motivation or inability to complete tasks), Interpersonal problems (difficulty making and keeping close relationships), Negative self-esteem (the belief that you are not good at anything). While any type of test is sure to make a child nervous, you can assure your child that there are no right or wrong answers. Important . These studies found no increased risk for suicidality associated with the use of antidepressant therapy. 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 USPSTF found 5 good- or fair-quality studies regarding the accuracy of MDD screening instruments in children and adolescents. 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). Depression might also cause a child to make trouble or act unmotivated, causing others not to notice that the child is depressed or to incorrectly label the child as a trouble-maker or lazy. Repeat screening may be most productive in adolescents with risk factors for MDD. Discover Pediatric Collections on COVID-19 and Racism and Its Effects on Pediatric Health. In addition, studies of paroxetine were excluded because of the 2003 FDA recommendation that this agent not be used to treat MDD in children and adolescents because of reports of possible suicidal ideation and suicide attempts in children and adolescents taking paroxetine for depression. Recommendations. 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. Or Sign In to Email Alerts with your Email Address, Screening for Depression in Children and Adolescents: US Preventive Services Task Force Recommendation Statement, Prioritized Agenda for Mental Health Research in Pediatric Rheumatology from the Childhood Arthritis and Rheumatology Research Alliance Mental Health Workgroup, Implementing the Patient Health Questionnaire Modified for Adolescents to improve screening for depression among adolescents in a Federally Qualified Health Centre, Runaway Youth: Caring for the Nations Largest Segment of Missing Children, Parent-Adolescent Agreement About Adolescents Suicidal Thoughts, Primary Care and Emergency Department Management of the Patient With Duchenne Muscular Dystrophy, Curriculum in Psychiatry and Neurology for Pharmacy Programs, Childhood Firearm Injuries in the United States, The frequent and underrecognised co-occurrence of acute exacerbated COPD and depression warrants screening: a systematic review, Mental Health Conditions and Medical and Surgical Hospital Utilization, on behalf of the US Preventive Services Task Force, DOI: https://doi.org/10.1542/peds.2015-4467. It can also be used as an instrument to monitor changes in depression symptoms over time. Treatment studies were limited to those that were implemented in primary care settings or received referrals from primary care settings to ensure that the population was similar to populations that would be identified through screening. Screening for Major Depressive Disorder in Children and Adolescents: A Systematic Review for the US Preventive Services Task Force. Pediatrics, November 1, 2010.. The number of items, administrative time to complete screening, and appropriate ages for screening vary. 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. Postpartum depression is the most common complication of childbearing. A comparison to its full-length. Daily Tips for a Healthy Mind to Your Inbox, Data and Statistics on Children's Mental Health, Is the children's depression inventory short version a valid screening tool in pediatric care? Hospital Anxiety and Depression Scale (or HADS) – Used for Anxiety & Depression can be used in community as well as hospital. 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 EPDS is easy to administer and has proven to be an effective screening tool. 4 Depression. This recommendation focuses on screening for MDD and does not address screening for other depressive disorders, such as minor depression or dysthymia. The USPSTF found no evidence on the current frequency of or methods used in primary care for screening for MDD in children. However, the magnitude of harms of pharmacotherapy is small if patients are closely monitored, as recommended by the US Food and Drug Administration (FDA). The USPSTF also revised the section on implementation to clarify that a range of staff types, organizational arrangements, and settings can support the goals of depression screening. MDD in children and adolescents is strongly associated with recurrent depression in adulthood; other mental disorders; and increased risk for suicidal ideation, suicide attempts, and suicide completion. Bodendorfer, Victoria MD; Borge, Robyn MD; Schuman, Catherine PhD. 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