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Screening gives providers insight about teen's risk for depression

DEAR MAYO CLINIC: At her most recent well-child checkup, my 13-year-old daughter was given a questionnaire about depression, even though she doesn't have any symptoms of depression. Is screening for depression typical at her age? If so, how are the answers used?

ANSWER: Major depression is common. It's estimated that up to 8 percent of teens have experienced depression in the past year. Untreated depression may place a teen at risk for recurrent depressive episodes or increase their risk of suicide. The risk factors for depression vary and include a family history of depression, age (a bit more common in older kids), and sex (more common in girls than boys). That said, it's important to understand that depression can happen in teens who don't have any of the typical risk factors.

It's standard practice for health care providers to screen for depression in all teens starting at age 12. The questions and answers can give a health care provider insight about whether a teen may be at risk for depression. They also can spark conversation about a teen's thoughts, feelings and behaviors. It's useful to repeat the questionnaire annually throughout the teen years so a health care provider can watch for changes that could indicate an increased risk for depression.

The form that's often used to screen for depression in teens is a patient health questionnaire called the PHQ-9 M. The "M" stands for "modified" because the questionnaire has been customized to be suitable for teens. It's short, with only nine questions, and takes less than five minutes to complete. It addresses topics such as how a teen is feeling, interest in activities, sleeping and eating patterns, concentration, and energy and activity levels. It also asks if a teen has had thoughts of hurting himself or herself.

Answers are given on a scale of 0 to 3 to identify how often in the previous two weeks the teen has had each of the symptoms listed. The questionnaire then asks how difficult the problems identified on the form have made daily life. The answers are scored, and the total score is placed on a continuum of depression severity that runs from no depression at the low end to severe depression at the high end. During the same visit, the provider and the teen talk about the answers and what the total score means.

The PHQ-9 M is a useful tool for uncovering important issues and concerns that should be addressed and that otherwise may not come up during a teen's well-child visit, such as feeling down, feelings of failure or thoughts of suicide. It also gives a health care provider the opportunity to probe further and find out more.

For example, if a teen answers "several days" to the question of how often he or she is "feeling bad about yourself - or feeling that you are a failure, or that you have let yourself or your family down," that will prompt follow-up questions from the health care provider. The two can discuss what's been going on in the teen's life to bring on those feelings, and if it may signal a larger problem.

If the score on the questionnaire indicates depression, the health care provider may refer the teen to a mental health specialist or recommend other follow-up treatment. It's important to note that the form is designed to show if a teen may be at an increased risk for depression or suicide. It is not intended as a tool to diagnosis depression, and it can't be used in place of a thorough evaluation with a health care provider.

Screening all teens for depression is important because depression is a serious mental health problem that requires treatment. In many cases, depression symptoms can get worse or lead to other concerns if left untreated. The sooner depression is identified, the sooner it can be addressed. For most teens with depression, treatment such as medication and psychological counseling can effectively ease symptoms and help them feel better. - Elizabeth Cozine, M.D., Family Medicine, Mayo Clinic, Rochester, Minn.


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