Posted by Michele Maddux on May 25, 2023
Why was this study done?
Depression is the number one health problem in adolescents, and by age 18, 20% of adolescents will experience a major depressive episode. For kids and teens with inflammatory bowel disease, the risk for depression is high. One in three adolescents struggle with some form of depression. Depression is linked to (associated with) difficulty adhering to medication, worsened disease activity, and higher healthcare costs. Yet, little is known about depression screening practices in pediatric IBD care. An improved understanding of current screening practices is an important step toward promoting mental health in pediatrics.
How was the study designed?
This study aimed to understand current practices surrounding depression screening at ImproveCareNow care centers. Out of 92 invited centers, 79 distinct pediatric practices/institutions completed a REDCap survey between November 2019 and April 2022. REDCap is a secure web platform for building and managing online databases and surveys. Data collected focused on clinical practices specific to depression screening including but not limited to:
- the involvement of various disciplines
- specific strategies used to monitor and treat symptoms of depression
- barriers experienced in relation to depression screening
What were the results?
Slightly more than half of participants (51.9%) reported doing depression screening as part of standard care, with 58.5% of this subset screening all IBD patients. Of centers doing depression screening to any degree, most centers do so among patients ages 12-14 using a validated screener such as the commonly used nine-question Patient Health Questionnaire (PHQ-9), and approximately half of centers report screening at every patient visit. This is mostly accomplished by having patients complete paper copies of depression screeners in the waiting room or during an appointment.
The PHQ-9 is a 9-item self-report questionnaire developed to screen for the presence and severity of depressive symptoms with one item about SI (suicidal ideation). Respondents indicate how much they have been bothered by various problems over the last two weeks on a 4-point scale ranging from ‘‘not at all’’ to ‘‘nearly every day.’’ An example of the PHQ-9 is included in the Depression Screening Toolkit available on the ICN Hub.
Please note: you will need an ICN Hub account to access the Depression Screening Toolkit. Contact us if you participate (this includes patients and parents/caregivers) at an ICN Center and need access to the ICN Hub.
For positive depression screens using the depression screening tool, most centers refer for evidence-based psychotherapy (e.g., cognitive-behavior therapy, counseling) and/or a psychosocial provider meets with the patient during that visit. Suicidal ideation is addressed by calling a psychosocial provider to clinic or sending a patient to the ED. Barriers to routine screening include lack of personnel/resources, billing for screening, and lack of clinic time.
What are limitations of this study?
Data was collected from centers during the COVID pandemic, and we did not assess if and how depression screening practices changed due to the pandemic. The use of telemedicine has increased to ensure the health and safety of patients and health care providers, and to maintain patient access to needed health care services. The rates of depression and other mental health needs have also skyrocketed during the COVID pandemic, causing an even greater need for depression screening. Future research is needed to better understand how screening practices have changed and the telemedicine models developed to screen patients across the virtual care platform.
What does this mean for patients, families and clinicians?
It is noteworthy that depression screening seems to predominantly occur with patients ages 14 or younger and few pediatric IBD providers screen older adolescents/young adults. Providers may have fewer resources and feel less equipped to meet the mental health needs of older adolescents and do not screen this age group as much. It may also be that by the time adolescents reach the age of 17, they are or are perceived to be established with mental health services and depression screening may be deemed unnecessary.
Most centers provide intervention in the presence of a positive depression screen, typically via a referral for evidence-based psychotherapy, (75.6%) or a psychologist or social worker meets with the patient during that visit (78.0%). When suicidal ideation is endorsed, 85.4% of centers call a social worker, psychologist, or crisis team to clinic and/or the patient is sent to the Emergency Department (58.5%). This may reflect variation in the level of psychosocial support present across pediatric IBD centers; that is, if a pediatric IBD center has access to a psychologist or social worker they are called to the clinic, whereas the absence of such support likely prompts a patient to be instead sent to the Emergency Department.
The most endorsed barrier(s) to routine screening included lack of manpower and resources, billing, and lack of clinic time. Resources needed to successfully implement depression screening included staff to administer screeners/rating scales, staff to provide intervention, and clinic time.
The ICN Psychosocial Screening Taskforce has developed tools to help doctors and patients overcome the barriers found by this study, including the development of the Depression Screening Toolkit. Created by the Social Workers & Psychology (SWAP) Workgroup, the Depression Screening Toolkit consists of eight modules with information on screening for depression during clinical visits. It includes workflow processes to implement screening at institutions with varying levels of staff and resources, as well as guidance for billing for screening and identifying psychosocial resources across ICN centers to support screening efforts.
Please note: you will need an ICN Hub account to access the Depression Screening Toolkit. Contact us if you participate (this includes patients and parents/caregivers) at an ICN Center and need access to the ICN Hub.
Study authors
Maddux MH, Drovetta M, Mackner LM, Plevinski J, Whitaker BN
Study status
Published in February 2023. You can locate it:
- On our website and online in the Journal of pediatric gastroenterology and nutrition
- Practice Survey: Depression Screening in Pediatric Inflammatory Bowel Disease. J Pediatr Gastroenterol Nutr. 2023 Feb 24:e003751. doi: 10.1097/MPG.0000000000003751. Epub ahead of print. PMID: 36821848.
About ICN Research Explained
We believe that in order to truly outsmart IBD, the questions we ask and the answers we find must be generated by and be useful to the people whose lives they will impact – patients and their families. ImproveCareNow (ICN) research is prioritized based on what matters most to patients and parents, and we are committed to sharing our results so everyone can understand and take advantage of what’s been learned. The ICN Research Committee has teamed up with patients and parents/caregivers to create and share accessible summaries of completed research called ICN Research Explained
Prepared by: Michele Maddux (first author) and Megan Kingsley Gale (parent)
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