Kaiser Permanente evidence review leads to new recommendation
(PORTLAND, Ore.)—The US Preventive Services Task Force now recommends screening adolescents aged 12 to 18 for depression when systems are in place to ensure accurate diagnosis, psychotherapy treatment and follow-up. In a separate recommendation, the Task Force found insufficient evidence to assess the balance of benefits and harms of screening children aged 7 to 11 for depression. The recommendations and summary of evidence appear in the April issue of Pediatrics.
The recommendations are based on an extensive scientific evidence review conducted by researchers at the Kaiser Permanente Center for Health Research, part of the Oregon Evidence-based Practice Center, which is funded by the Agency for Healthcare Research and Quality (AHRQ). The Task Force, which is supported by AHRQ, is the leading independent panel of experts in prevention and primary care and conducts rigorous, impartial assessments of the scientific evidence for the effectiveness of a broad range of clinical preventive services, including screening, counseling and preventive medications.
“As many as 20% of adolescents have experienced depression, but the majority of them are not diagnosed or treated,” says Selvi Williams, MD, MPH, a Kaiser Permanente Center for Health researcher who led the evidence review. “I am hopeful that this new recommendation will lead to more young people with depression getting the help they need.”
Dr. Williams and her team reviewed new evidence on the benefits and harms of screening children and adolescents for depression, the accuracy of screening tests administered in the primary care setting and the benefits and risks of treating depression using psychotherapy and/or medications in patients aged 7 to 18.
They found that depression screening tests developed for use by primary care clinicians successfully detect depression in adolescents, but the researchers could not find enough evidence that these same screening tests successfully detect depression in children.
There is adequate evidence that treating adolescents with selective serotonin reuptake inhibitors (SSRIs), psychotherapy or a combination of both decreases their depressive symptoms. SSRIs have also been shown to reduce depression symptoms in children; however, there are limited data on the benefits of psychotherapy and combined therapy in children. Treating depressed youth with SSRIs is associated with a slight increase in risk of suicidal thoughts and behavior and, therefore, should only be considered if careful clinical supervision is possible. Suicide is the third leading cause of death among people aged 15 to 24 and the sixth leading cause of death among those aged 5 to 14.
Depression is an important cause of poor health and lower quality of life in children and adolescents. Poor performance in school, poor social functioning, early pregnancy, increased sickness, and substance abuse can also result from depression.
Adolescents are at higher risk for depression when they have other mental health conditions, have experienced a major negative life event or have parents with depression.
Kaiser Permanente Center for Health Research conducts evidence reviews for the US Preventive Services Task Force, which is the leading independent panel of experts in prevention and primary care. Its recommendations are considered the gold standard for clinical preventive services.