Rate of Depression Screening And Factors Correlated With Screening In A National Sample of Adolescent Provider Visits

Nadja Peter; Sarah R. Green; Edward Gracely

doi:10.1016/j.jadohealth.2018.10.150

Purpose It is estimated that 12.8% of adolescents had a major depressive episode in 2016; yet only 40% of these received treatment. Guidelines emphasize the importance of screening for depression, but depression screening among adolescents remains very low. Previous studies have shown females, older teens, and non-Latino patients were more likely to be screened; female providers and more recent medical school graduates were more likely to screen. Our study aims to determine the rate of depression screening in a national sample and evaluate patient, provider and practice factors that are associated with increased screening rates. Methods The 2012 National Ambulatory Medical Care Survey (NAMCS) was utilized to identify a sample of visits by 10-21 year-old patients. The survey provides information about use of ambulatory medical services in the United States. The primary outcome assessed was “depression screening.” Visits to psychiatrists and visits by patients with known depression were excluded. Pregnancy status, contractors, and physician assistants were excluded because the number of visits was too small for statistical significance. Bivariate analyses, using complex samples chi-square, compared groups on patient, provider and practice factors that have been identified in prior literature as possible influences on screening rates, as well as novel ones such as use of an electronic medical record (EMR). Multivariate analysis using complex samples logistic regression (SPSS V24) was performed with the dichotomous depression screening variable as the outcome. All potential predictors that were significant (p <= 0.05) or nearly significant (p <= 0.10) in the bivariate analyses were included. The study was exempted from IRB review. Results Overall, depression screening occurred at 1.1% of visits. In bivariate analysis, a number of patient/visit variables predicted increased likelihood of screening (such as obesity and spending more time with the physician), as did several practice variables (such as solo practice and EMR reminders). In no subgroup, as defined by the individual predictors, including having reminders or EMR, did screening rates exceed 7%. In multivariate analyses, patient/visit factors that predicted increased depression screening included the patient having two or more chronic conditions, the visit being with a nurse practitioner, the visit being for preventive care or follow-up of a chronic problem, and more time spent with the physician Provider/practice factors that predicted increased screening were, the physician being full-owner of the practice and not making hospital visits, and the practice having, but only partially using, an EMR. When the EMR variable was excluded, having electronic reminder systems for guideline-based care became predictive. Conclusions Depression screening at adolescent visits remains exceedingly low. Certain factors are associated with modestly increased screening. More frequent preventive and follow-up visits, longer visits, and use of an EMR and electronic reminders for screening, could be utilized to improve screening in the future. However, further studies, such as provider interviews, are needed to identify and address additional barriers to more comprehensive screening.

Rate of Depression Screening And Factors Correlated With Screening In A National Sample of Adolescent Provider Visits

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Rate of Depression Screening And Factors Correlated With Screening In A National Sample of Adolescent Provider Visits

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