Routine depression screenings of teens could prevent recurrence, study finds

Nearly all adolescents treated for the illness recover, but almost half relapse within five years.

By — Posted Nov. 17, 2010

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Conducting regular depression screenings for adolescents who have had major depressive disorder could prevent the condition from recurring, according to new research.

A study published online Nov. 1 in the Archives of General Psychiatry found that nearly all adolescents treated for major depression will recover. But almost half will have a recurrence within five years.

The findings indicate "that there's a very high chance a person is going to get better. ... Doctors can convey that hopefulness to families and patients. But physicians have to be aware that [depression] could occur again," said lead study author John Curry, PhD, professor of medical psychology in the Dept. of Psychiatry and Behavioral Sciences at Duke University Medical Center in Durham, N.C.

Curry encourages physicians to screen such patients for depression symptoms, such as trouble sleeping and eating, during regular office visits. Major depressive disorder is one of the most prevalent psychiatric conditions among adolescents, according to the study. It affects about 5.9% of females and 4.6% of males in this age group.

Researchers followed the progress of 196 people, age 17 to 22, who had participated in the Treatment for Adolescents with Depression Study. They examined rates of recovery from major depressive disorder and recurrence of the condition during the 21-month depression treatment study and 3.5 years of follow-up.

They found that 96.4% recovered from their major depressive episode during the study period of more than five years. Of those patients, however, 46.6% had at least one recurrence of major depression (link).

Recurrence was more common among females (57%) than males (32.9%). It also occurred more frequently in adolescents with anxiety disorder (61.9%) than in those without the condition (42.2%). The type of medical care individuals received in the depression treatment study -- fluoxetine hydrochloride, a placebo, cognitive behavioral therapy or a combination of medication and therapy -- did not affect their depression recurrence rate.

Screening for depression

Primary care physicians can use the Patient Health Questionnaire-9 to identify major depression in adolescents, according to a study published online Nov. 1 in Pediatrics. The PHQ-9 is widely used for adults, but had not been validated in adolescents before the study, said lead author Laura P. Richardson, MD, MPH, an associate professor of pediatrics at the University of Washington School of Medicine in Seattle.

"The nice thing about the PHQ-9 is that it is easy to obtain, score and use. And it fosters good conversation" between the physician and patient, said Dr. Richardson, an adolescent medicine specialist at Seattle Children's Hospital.

Researchers examined data on 442 youths, ages 13 to 17, who were enrolled in Group Health, a health care system in the Pacific Northwest. Participants were recruited for the study between September 2007 and June 2008. Their depressive symptoms were assessed using the Patient Health Questionnaire-2, the PHQ-9 and the Diagnostic Interview Schedule for Children.

Researchers found that the PHQ-9's sensitivity for detecting major depression among adolescents and its specificity is similar to other screening tools used in this age group (link). The study authors suggest that primary care physicians initially screen adolescents for depression with the PHQ-2, which features the first two questions of the PHQ-9. Those patients with a score of three or higher should receive the nine-question survey, which has better specificity for detecting major depression than the PHQ-2 and includes a question on suicide.

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