Treatment Engagement Following a Positive Mental Health Screening Questionnaire

Published:February 28, 2022DOI:


      Less than half of U.S. adolescents with major depressive disorder receive treatment. Despite the U.S. Preventive Services Task Force 2016 statement supporting primary care major depressive disorder screening, there is limited data examining whether positive screens prompt treatment engagement. This study evaluated treatment engagement following a positive Patient Health Questionnaire-Adolescent Version screen and assessed the impact of demographics, clinical variables, and provider recommendations on treatment engagement.


      This was a retrospective cohort study (analysis November 2021) of adolescents aged 11–18 years seen at a primary care clinic of an academic medical center from July 2017 to December 2018 and identified with a positive Patient Health Questionnaire-Adolescent Version (broadest definition score ≥10; ≥1 for Item 9 regarding suicidal thoughts; yes for unscored Items 1, 3, or 4; or very or extremely difficult for unscored Item 2). Positive screen by score ≥10 alone was also considered. The primary outcome was treatment engagement, defined as initiation of a psychotropic medication, or a behavioral health treatment session within 1 year of symptom identification.


      Of the 1,315 eligible adolescents, 23.0% had a positive Patient Health Questionnaire-Adolescent Version (n=302) by the broadest criteria; 92/302 (30.5%) engaged in treatment. Patients whose providers recommended treatment had 7.32 times the odds (95% CI=3.76, 14.2, p<0.001) of treatment engagement. For those positive by Patient Health Questionnaire-Adolescent Version ≥10 (85/302, 28.1%), 37/85 (43.5%) engaged in treatment. The influence of provider recommendations was comparable (OR=6.96, 95% CI=3.56, 13.6, p<0.001).


      Less than half of adolescents with a positive Patient Health Questionnaire-Adolescent Version at an academic primary care clinic engaged with treatment. Provider recommendation was an impactful intervention to improve mental healthcare treatment engagement.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to American Journal of Preventive Medicine
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Merikangas KR
        • He JP
        • Burstein M
        • et al.
        Lifetime prevalence of mental disorders in U.S. adolescents: results from the National comorbidity Survey Replication–Adolescent Supplement (NCS-A).
        J Am Acad Child Adolesc Psychiatry. 2010; 49: 980-989
        • Substance Abuse and Mental Health Services Administration
        Key substance use and mental health indicators in the United States: results from the 2019 National Survey on Drug Use and Health (HHS Publication No. PEP20-07-01-001, NSDUH Series H-55).
        Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration, Rockville, MD2020 (Accessed September 16, 2021)
        • Siu AL, U.S. Preventive Services Task Force
        Screening for depression in children and adolescents: U.S. Preventive Services Task Force recommendation statement.
        Ann Intern Med. 2016; 164: 360-366
        • Verboom CE
        • Sijtsema JJ
        • Verhulst FC
        • Penninx BW
        • Ormel J.
        Longitudinal associations between depressive problems, academic performance, and social functioning in adolescent boys and girls.
        Dev Psychol. 2014; 50: 247-257
        • Hacker K
        • Arsenault L
        • Franco I
        • et al.
        Referral and follow-up after mental health screening in commercially insured adolescents.
        J Adolesc Health. 2014; 55: 17-23
        • Chowdhury T
        • Champion JD.
        Outcomes of depression screening for adolescents accessing pediatric primary care-based services.
        J Pediatr Nurs. 2020; 52: 25-29
        • Johnson JG
        • Harris ES
        • Spitzer RL
        • Williams JB.
        The patient health questionnaire for adolescents: validation of an instrument for the assessment of mental disorders among adolescent primary care patients.
        J Adolesc Health. 2002; 30: 196-204
        • Behrens B
        • Swetlitz C
        • Pine DS
        • Pagliaccio D.
        The Screen for Child Anxiety Related Emotional Disorders (SCARED): informant discrepancy, measurement invariance, and test–retest reliability.
        Child Psychiatry Hum Dev. 2019; 50: 473-482
        • Radez J
        • Reardon T
        • Creswell C
        • Lawrence PJ
        • Evdoka-Burton G
        • Waite P.
        Why do children and adolescents (not) seek and access professional help for their mental health problems? A systematic review of quantitative and qualitative studies.
        Eur Child Adolesc Psychiatry. 2021; 30: 183-211
        • Reardon T
        • Harvey K
        • Baranowska M
        • O'Brien D
        • Smith L
        • Creswell C
        What do parents perceive are the barriers and facilitators to accessing psychological treatment for mental health problems in children and adolescents? A systematic review of qualitative and quantitative studies.
        Eur Child Adolesc Psychiatry. 2017; 26: 623-647
        • Zuckerbrot RA
        • Cheung A
        • Jensen PS
        • Stein REK
        • Laraque D
        Guidelines for adolescent depression in primary care (GLAD-PC): Part I. Practice preparation, identification, assessment, and initial management.
        Pediatrics. 2018; 141e20174081
        • Lu W.
        Treatment for adolescent depression: national patterns, temporal trends, and factors related to service use across settings.
        J Adolesc Health. 2020; 67: 401-408
        • Merikangas KR
        • He JP
        • Burstein M
        • et al.
        Service utilization for lifetime mental disorders in U.S. adolescents: results of the National Comorbidity Survey-Adolescent Supplement (NCS-A).
        J Am Acad Child Adolesc Psychiatry. 2011; 50: 32-45
        • Ginsburg AD
        • Stadem PS
        • Takala CR
        • et al.
        An examination of screening tools for collaborative care of adolescent depression.
        J Clin Psychiatry. 2018; 79: 17m11543
        • Pop R
        • Kinney R
        • Grannemann B
        • Emslie G
        • Trivedi MH.
        VitalSign: screening, diagnosis, and treatment of depression for adolescents presenting to pediatric primary and specialty care settings.
        J Am Acad Child Adolesc Psychiatry. 2019; 58: 632-635