Screening for Depression and Anxiety in Our Youth

Mike Guyton, MDAssistant Clinical Professor/Academic

Faculty in General Pediatrics

Objectives

• Current burden of mental illness among youth

• Impact of early recognition• Introduction of screening tools used

at CPM– PHQ-9 Screen for Depression– SCARED Questionnaire for Anxiety

Current Burden of Mental Illness Among Youth

• Depression– Point prevalence in those 4-17yo estimated to be 3-3.5%– Lifetime prevalence as high as 7-8%

• Relapse as high as 40% in 2 years

– F:M 2:1; increased risk to those born in latter half of 20th century

• Anxiety– Usually co-morbid with depression

• Estimated to be current in ~3% of those 3-17yo

• Suicide– 3rd leading cause of death among all children and adolescents

in the US– In 2010, rates estimated to be 4.5/100,000 youth 10-19yo– Overall, rates of pediatric suicide are increasing

Pediatric Suicides

• Suicidal Ideation (SI) Suicide Attempt Completed Suicide– Of those with SI, ~34 percent attempt– 50-100 attempts for every completed suicide

• Several Mechanisms Used– Hanging/Suffocation and Firearms most common among

adolescents

• Patterns discovered based on retrospective studies– 29.5% disclosed intent prior to suicide– 35.5% with a diagnosed mental illness at time of suicide– 26.4% were undergoing treatment at time of suicide– 21.1% had a previous attempt at time of successful

suicide

Impact of Early Recognition

• Concern that talking/asking about mental illness/suicide will initiate suicidal actions/ideation– NOT supported by the medical literature and

evidence

• Long term consequences of co-morbid mood/anxiety disorders – Poor psychosocial functioning– Lower educational attainment– Impaired functioning in multiple domains

• Work, family, and parenting

What Makes Identification Tough

• Kids/Adolescents have many reasons to hide their feelings of depression/anxiety– Fear of Stigma– Belief that depression is not treatable by primary

care docs– Depression is not a “real” illness, but instead a

personal flaw– Concerns about confidentiality– Do not want medication or involvement of a

psychiatrist

Screening for Depression and Suicide: The PHQ-9

• Multipurpose instrument for screening, diagnosing, monitoring, and measuring depression severity

• Completed by the patient– Validity decreased if completed by a guardian or

parent

• Diagnostic validity established in studies from Primary Care and Obstetric clinics

• Scores > or = to 10 had a Sensitivity and Specificity of 88% for Major Depression– Sensitivity: Helps to rule out disease (SNOUT)– Specificity: Helps to rule in disease (SPIN)

The Questionnaire

Scoring

Screening for Anxiety: The SCARED Questionnaire

• Screens for the presence of Anxiety– Self-Report for Childhood Anxiety Related Disorders

• Used to detect clinically significant anxiety problems in children and adolescents

• Indicates answers that could represent a particular form of anxiety– Panic Disorder/Somatic Symptoms– Generalized Anxiety Disorder– Separation Anxiety– Social Anxiety– School Avoidance

• Given to both child and the parent– May be read aloud for the child when given

The Questionnaire

Scoring of SCARED

Utility in the School Setting

• Both Tools are easily available for teachers and staff to use

• Caveat: “Next Step” in care needs to be identified and streamlined– Referral to school social worker– Review of academic stressors and

responsibilities

• Best Initial Step: Encourage patient and parents to speak with their physician regarding concerns

Questions?