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
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.