Treatment options for MDD in children and adolescents include pharmacotherapy, psychotherapy, collaborative care, psychosocial support interventions, and complementary and alternative medicine approaches. 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). No trials of psychotherapy or combined interventions in children examined harms. 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. 7 If the PCP believes that an adolescent with a score of 5-9 has symptoms that are Health Care Into Pediatric Practice, and Chapter2, Pediatric Care of Children and AdolescentsWith Mental Health Problems. POPULATION: This recommendation applies to children and adolescents aged ≤18 years who do not have an MDD diagnosis. There are five subscales within the assessment that measure different components of depression: The CDI is popular in part because it is easy to administer and score. 1 Month 2 Month 4 Month 6 Month. 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. 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. Tool by Author/Owner. The number of items, administrative time to complete screening, and appropriate ages for screening vary. 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) • Use of screening tools to aide in identification of children and adolescents with depression and anxiety disorders . The authors declare no conflicts of interest. Updated April 19, 2019. Patients randomly assigned to the collaborative care group had an initial in-person session that included their parents, choice of treatment type(s), and regular follow-up with depression care managers (28% received psychotherapy alone, 4% received pharmacotherapy alone, and 54% received both). Morsa Images / DigitalVision / Getty Images. Adults. What Parents Should Know About Childhood Depression, Benefits of Children Taking Antidepressants Can Outweigh the Risks, Psilocybin Effective for Treating Major Depressive Disorder, Research Suggests, The 7 Best Online Therapy Programs for Kids in 2021. AHRQ Publication No. A list of the current USPSTF members is available at www.uspreventiveservicestaskforce.org/Page/Name/our-members. Children’s symptom and social functioning self-report scales: Comparison of mothers’ and children’s reports. Depression Scale for Children (DSC) The Center for Epidemiological Studies Depression Scale for Children (DSC) is a 20-item self-report for children and adolescents ages 6 to 17 years that screens for depression. 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. Rather, the goal is for the results of the test to be shared with your doctor to inform further conversations about diagnosis and treatment. Evidence on the harms of psychotherapy and the combination of psychotherapy and SSRIs in children is limited. Finally, inadequate support and follow-up may result in treatment failures or harms, as indicated by the FDA boxed warning. Tool for Families: Symptoms of Depression in Adolescents, p. 126. Milder symptoms may respond well to support and self-care, while more moderate to severe symptoms may require other treatments such as medications or psychotherapy. Screen yourself or a family member for an anxiety disorder, depression, OCD, PTSD, or a phobia. Cognitive-behavioral treatment of adolescent depression: efficacy of acute group treatment and booster sessions. It is useful in patients who are unlikely to call for help if needed i.e. Newer studies do not provide much additional evidence on treatment harms in children and adolescents but do not suggest more risks. Gundersen Health System Family Medicine Residency, La Crosse, WI. MDD is associated with significant morbidity and mortality. A double-blind, randomized, placebo-controlled trial of escitalopram in the treatment of pediatric depression. The BDI can be used for ages 13 to 80. Risk factors for MDD in children and adolescents include female gender, older age, family (especially maternal) history of depression, previous episode of depression, other mental health/behavioral problems, chronic medical illness, overweight and obesity, and, in some studies, Hispanic race/ethnicity. Depression screening, reported with 96127, is typically a covered preventive service for adolescents age 12 to 18 and is a quality measure in many pediatric quality initiatives. 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). Little is known about the prevalence of MDD in children aged ≤11 years. 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. The CDI was tested on a large group that represents the population of children in the United States. A list of examples of validated screening tools is available from the American Academy of Pediatrics external icon. Understanding Your Liebowitz Social Anxiety Scale (LSAS) Results. One good-quality study (N = 221) compared fluoxetine with placebo in adolescents aged 12 to 17 years.10–12 Two fair-quality studies (N = 268 and 316, respectively) compared escitalopram with placebo in children and adolescents13 and adolescents only.14 One fair-quality study (N = 178) compared citalopram with placebo in children and adolescents.15 The absolute difference in response favored SSRIs in all 4 studies, ranging from 2.4% to 25%, and was significant in 2 of the 4 trials. 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. 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 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. Screening negative on a screening test, however, does not always preclude referral when clinical judgment or parental concerns suggest otherwise. The USPSTF found adequate evidence that screening test results can be used to accurately identify MDD in adolescents. Started in 1995, this collection now contains 6881 interlinked topic pages divided into a tree of 31 specialty books and 737 chapters. The systematic review had eligibility requirements that excluded studies with subjects who had comorbid disorders. Read more about online mental health screenings. The CDI is designed to detect symptoms of depression and to distinguish between depression and other psychiatric disorders. Screening for Depression in Children and Adolescents: Clinical Summary. • A total PHQ-9 score > 10 (see below for instructions on how to obtain 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. The mean age of onset of MDD is ∼14 to 15 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 … 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. What are the best screening tools for assessing depression and anxiety in children and adolescents? New York: Springer; 2009. Rather, the goal is for the results of the test to be shared with your doctor to inform further conversations about diagnosis and treatment. Treatment options for depression include pharmacologic, behavioral, multimodal, and collaborative care models, some of which require coordination. 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). *For children ages 8 to 11, it is recommended that the clinician explain all questions, or have the child answer the questionnaire sitting with an adult in case they have any questions. Tool for Families: Common Signs of Depression in Children and Adolescents, p. 147. In nationally representative US surveys, ∼8% of adolescents reported having major depression in the past year. 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. It is a 14 question Psychological screening tool assessing the severity of symptoms. Another sample of the PHQ-9 Modified for Teens is available through the Community Care of North Carolina. Initial screening in patients who may have depression NICE recommends that any patient who may have depression (especially those with a past history of depression or who suffer from a chronic physical illness associated with functional impairment) should be asked the following two questions [ … Little is known about the prevalence of MDD in children. A randomized, placebo-controlled trial of citalopram for the treatment of major depression in children and adolescents. An accurate diagnosis can only be made through clinical evaluation. The American Academy of Pediatrics’ Bright Futures program recommends screening annually in child and adolescent patients for emotional and behavioral problems.18 Medicaid’s child health component (the Early and Periodic Screening, Diagnostic, and Treatment program) recommends screening to detect physical and mental conditions at periodic, age-appropriate intervals and, if risk is identified, to follow up with diagnostic and treatment coverage.19 The Canadian Task Force on Preventive Health Care states that there is insufficient evidence to recommend for or against screening for depression in children or adolescents in primary care settings.20. 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. This self-test is for personal use only. 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. I … Department of Geriatrics and Palliative Medicine, Mount Sinai School of Medicine, New York, New York. Based on a previous review, the USPSTF concludes that the use of SSRIs in children is associated with harms, specifically risk for suicidality. 7 The HEADS mnemonic has different variations, such as the HEADDS or HEEADSSS, but with commonality among all of them. Patients randomly assigned to the usual care control group received screening results and could access mental health services through the usual health care system. Important . Read our, Reviewed by Ann-Louise T. Lockhart, PsyD, ABPP, Medically reviewed by Daniel B. Other self-report assessments for identifying depression in children include the Beck Depression Inventory (BDI) and the Weinberg Screening Affective Scale (WSAS). The USPSTF found no direct evidence regarding the harms of screening for MDD in adolescents or children. Cognitive-behavioral therapy is one form of therapy that is used to treat anxiety or depression, particularly in older children. Recommended Screening. 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. This 116. Recommended Screening. Some research indicates, however, that the test is not appropriate for children who have reading difficulties. dementia, delirium or children. Included here are two versions, the parent … With each question, think about how you've been feeling over the last 2 weeks. Kovacs M. Children's Depression Inventory (CDI). 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). Bodendorfer, Victoria MD; Borge, Robyn MD; Schuman, Catherine PhD. The BDI takes approximately 10 minutes to complete. Escitalopram in the treatment of adolescent depression: a randomized placebo-controlled multisite trial. The USPSTF commissioned a systematic evidence review to update the 2009 USPSTF recommendation on screening for child and adolescent MDD among primary care populations.3,4 To focus on the population most likely to benefit from screening and intervention, the scope of the review was narrowed to focus on screening for and treatment of MDD. 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, … The ASQ is free of charge and available in multiple languages. The CES-D as a screen for depression and other psychiatric disorders in adolescents. Learn more about depression in children external icon 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. Bright Futures Tool & Resource Kit econd dition User Guide and Instructions for Toolkit Implementation Making the Most of the Supporting Materials in the Toolit Links to Commonly Used Screening Instruments and Tools The American Academy of Pediatrics does not approve nor endorse any specific tool for screening purposes. FINANCIAL DISCLOSURE: The authors have indicated they have no financial relationships relevant to this article to disclose. Remission and residual symptoms after short-term treatment in the Treatment of Adolescents with Depression Study (TADS). No studies found significant differences, although none of the studies was sufficiently powered for this outcome. No studies examined subgroup differences in harms. Additional materials to help with suicide risk screening implementation are available in The Ask Suicide-Screening Questions (ASQ) Toolkit, a free resource for use in medical settings (emergency department, inpatient medical/surgical … Aron Janssen, MD is board certified in child, adolescent, and adult psychiatry and is the vice chair of child and adolescent psychiatry Northwestern University. Some researchers have also observed that children who do not have age-appropriate reading skills may receive an inaccurate diagnosis on the basis of their CDI score. The USPSTF found no evidence on appropriate or recommended screening intervals, and the optimal screening interval is unknown. Other psychosocial risk factors for MDD include childhood abuse or neglect, exposure to traumatic events (including natural disasters), loss of a loved one or romantic relationship, family conflict, uncertainty about sexual orientation, low socioeconomic status, and poor academic performance. It also discriminates between ma… 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. The Beck Depression Inventory (BDI) is widely used to screen for depression and to measure behavioral manifestations and severity of depression. 5 Depression: Incidence/Prevalence • In 2015, 30% of H.S. Recommendations made by the USPSTF are independent of the US government. Results were not stratified according to age, gender, or ethnicity. Edinburgh Postpartum Depression Scale (EPDS) a. García, MD, MPH (Pima County Department of Health, Tucson, AZ); Matthew Gillman, MD, SM (Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA); Jessica Herzstein, MD, MPH (independent consultant, Washington, DC); Alex R. Kemper, MD, MPH, MS (Duke University, Durham, NC); Alex H. Krist, MD, MPH (Fairfax Family Practice, Fairfax, and Virginia Commonwealth University, Richmond, VA); Ann E. Kurth, PhD, RN, MSN, MPH (New York University, New York, NY); Douglas K. Owens, MD, MS (Veterans Affairs Palo Alto Health Care System, Palo Alto, and Stanford University, Stanford, CA); William R. Phillips, MD, MPH (University of Washington, Seattle, WA); Maureen G. Phipps, MD, MPH (Brown University, Providence, RI); and Michael P. Pignone, MD, MPH (University of North Carolina, Chapel Hill, NC). This guideline covers identifying and managing depression in children and young people aged 5 to 18 years. 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). 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. Data and Statistics on Children's Mental Health. It is important that childhood depression is treated quickly. We do not capture any email address. Both the American Academy of Pediatrics and the U.S. Preventive Services Task Force recommends that depression screening be conducted annually. Among children and adolescents aged 8 to 15 years, 2% of boys and 4% of girls reported having MDD in the past year. 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? It is a compilation of tools that are potentially useful at each stage of a clinical process through which mental health content can be integrated into pediatric primary care. A requirement for effective screening is a screening tool with demonstrated high accuracy. Therefore, the USPSTF concludes with moderate certainty that screening for MDD in adolescents aged 12 to 18 years is associated with moderate net benefit. Collaborative care for adolescents with depression in primary care: a randomized clinical trial. REFERENCES Weissman MM, Orvaschel H, Padian N. 1980. Screening positive on an initial screening test does not necessarily indicate the need for treatment. 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%). 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 CDI is a quick and painless depression assessment for your child. Screening positive on an initial screening test does not necessarily indicate the need for treatment. Recommended Visit. Evidence Synthesis No. Centers for Disease Control and Prevention. The CDI is used to scale the severity of depressive symptoms in children. Many different screening tools are available to identify depression in children and adolescents, and some have been used in primary care. Important Information: Diagnostic criteria for a major depressive episode are slightly different for adults and children or adolescents in the DSM-IV-TR. Enter multiple addresses on separate lines or separate them with commas. 2 The 10-question Edinburgh Postnatal Depression Scale (EPDS) is a valuable and effici ent way of identifying patients at risk for “perinatal” depression. The authors declare no conflicts of interest. Objective: Depression screening among children and adolescents is controversial, and no clinical trials have evaluated benefits and harms of screening programs.
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