Screening for Current or Past Symptoms of Depression, Anxiety, and Suicidal Ideation

Background and Purpose:The passage of the 2010 Patient Protection and Affordable Care Act (PPACA) signaled a change in the approach to health care away from specialty services and towards primary care services. One of those changes is the increased integration of physical and behavioral health care in primary care settings. For mental health services to youth, the focus on primary care holds promise:  nearly 70% of adolescents visit a primary care provider (PCP) each year and many adolescents report a willingness to talk to their medical provider about mental health problems. As a result, there is a growing interest in the feasibility of screening adolescents for mental health problems in primary care.  It has been estimated that 9% of adolescent patients are experiencing depression, 6-20% are suffering from an anxiety disorder, and 13% are having suicidal thoughts. Consequently, best practice recommendations now encourage screening for behavioral health concerns at least at a pediatric well visit, but preferably at all visits. One of the limitations of current screening tools is that most only ask about symptoms in the past week or two. This presents particular limitations because a high percentage of patient contact is at a yearly well visit. Serious behavioral health concerns may go undetected if patients are only asked once a year about symptoms in the past two weeks. Therefore, the purpose of this study is to examine whether additional high risk youth are identified when screening for past year symptoms of depression and anxiety, and lifetime symptoms of suicide ideation.  A second purpose is to examine if frequency, in addition to presence, of past symptoms is associated with increased odds of endorsing risk behaviors.

Methods:415 adolescents, aged 12 – 21 years old (M = 15.8, SD = 2.2) completed the Behavioral Health Screen in four urban primary care offices.  The BHS assesses current and past symptoms and is a web-based, psychosocial screening tool designed for primary care settings. Simple descriptive statistics odds ratios were used to answer the research questions.    

Results:  When asked about symptoms in the past year, even with the absence of current symptoms, an additional 22% of adolescents endorsed depression symptoms, 9% endorsed anxiety symptoms, and 13% reported suicidal ideation (in their lifetime).  Adolescents who endorsed symptoms in the past had significantly greater odds of displaying other risk behaviors than those who endorsed no symptoms at all, but lower odds than those with current symptoms.  Youth reporting frequent past symptoms had a similar level of risk for other psychiatric and risk behaviors, as those patients who endorse current symptoms . 

Conclusions and Implications: The 2010 PPACA has provided a financial incentive to integrate physical and behavioral health care in primary care. This presents a significant opportunity for social workers to provide mental health services to youth in primary care settings. By screening for current and past symptoms, the BHS provides more accurate identification of youth with serious depressive and anxiety symptomology and suicidal ideation.