Studies Needed to Determine Effects of Screening for Depression on Health Outcomes for Children and Adolescents
According to a recent study by researchers including Michelle Roseman, a second-year postgraduate student at the University of Toronto Department of Family and Community Medicine (DFCM) and resident at Mount Sinai Hospital, there is no direct evidence that routine depression screening among children and adolescents leads to better mental health outcomes.
“We determined that there has been no randomized controlled trial that has evaluated whether depression screening improves depression outcomes among children and adolescents,” says Roseman.
Depression is a disabling condition for children and adolescents. Screening, one of the proposed ways to improve depression management requires a person to complete a self-reported questionnaire on depression symptoms. A healthcare provider then calculates the responses’ scores. The respondent may be living with depression should the score be above a threshold. Roseman doubts its efficacy.
“Not one single questionnaire, out of the many available, can reliably identify children or adolescents who have depression and rule out those who do not. If depression screening were put into practice using existing tools, many children and adolescents who are not depressed would be mistakenly labelled as depressed.”
While Roseman began her research when she was completing her master’s degree at McGill, she published the findings during her first year of residency at DFCM. She was involved in a similar study which found no evidence that routine depression screening leads to better mental health outcomes among adults.
“Through screening, you will almost certainly diagnose more people as depressed, but would it lead to better outcomes?” she says. “It is not beneficial to people to get a diagnosis unless that leads to better health outcomes. As healthcare practitioners, if we are to screen, we need to know that we are improving depression outcomes. That is what well-designed trials for depression screening would need to show.”
Roseman notes that screening programs are resource intensive and costly for the already-strained Canadian medical system which is providing care and treatment for youth known to have severe mental health problems. She is also concerned that routine screening might cause harm to some children and adolescents who are screened for depression. Children who are screened and incorrectly diagnosed could face stigma from being labelled as living with depression and subjected to treatments that would not likely help. At times, the results are adverse of what was intended.
“Depression is a problem, and primary care practitioners should be alert to symptoms of depression in their young patients. We should be investing in better treatment and follow up for those we already know are living with depression. We also need to invest in better access to mental health programs and treatment for all.”