Task Force Recommends Screening Adolescents for Clinical Depression

The U.S. Preventive Services Task Force now recommends screening adolescents for clinical depression only when appropriate systems are in place to ensure accurate diagnosis, treatment and follow-up care. This applies to all adolescents 12 to 18 years of age. In a separate recommendation, the Task Force found insufficient evidence to assess the balance of benefits and harms of screening children 7 to 11 years of age for clinical depression. The recommendations and the accompanying summary of evidence appear in the April issue of Pediatrics.

The Task Force reviewed new evidence on the benefits and harms of screening children and adolescents for clinical depression, the accuracy of screening tests administered in the primary care setting and the benefits and risks of treating clinical depression using psychotherapy and/or medications in patients 7 to 18 years of age. Clinical depression is an important cause of poor health and lower quality of life among children and adolescents. Depression can cause difficulties in school and disruptions of family and social relationships as well as diminished quality of life.

"Depression in adolescents has a significant impact on both mental and physical health, and adolescents with depression have more hospitalizations for psychiatric and medical issues than adolescents who are not depressed," said Task Force Chair Ned Calonge, M.D., who is also chief medical officer for the Colorado Department of Public Health and Environment. "It is important that adolescents are diagnosed and treated for clinical depression in order to improve their health and quality of life, especially if they have a family history of depression."

There is adequate evidence that treating adolescents with selective serotonin reuptake inhibitors (SSRIs), psychotherapy or combined therapy (SSRIs and psychotherapy) result in decreased clinical depression symptoms. Treating clinically depressed youths with SSRIs is associated with an increased risk of suicidality (suicidal thoughts, preparation and attempts of suicide) and, therefore, should only be considered if careful clinical supervision is possible.

Depressed children and adolescents are at an increased risk of suicide, which is the third-leading cause of death among people age 15 to 24 and the sixth-leading cause of death among those age 5 to 14. Adolescents suffering from clinical depression are also more likely to suffer from depression in early adulthood. Nearly 6 percent of adolescents 13 to 18 years of age are clinically depressed, and it is more common among girls than boys.

The Task Force is the leading independent panel of experts in prevention and primary care. The Task Force, which is supported by the Agency for Healthcare Research and Quality, 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. Its recommendations are considered the gold standard for clinical preventive services. The Task Force based its conclusions on a report from a research team led by Selvi Williams, M.D., at the Kaiser Permanente Center for Health Research, which is part of AHRQ's Oregon Evidence-based Practice Center.