Literature Collection

PURPOSE: Adolescent depression screening in primary care is recommended yet little is known about its implementation and outcomes. We assessed rates of screening, "positive" screening and later diagnosis of depression. METHODS: This retrospective cohort study included 751,876 adolescents aged 11-17.99 years from 1/1/2017-12/31/2021 at a large integrated healthcare system in Southern California with comprehensive electronic medical records (EMR). Screening for depression was implemented at primary care using the abbreviated Patient Health Questionnaire (PHQ). All data were extracted from EMR. Rates of depression screening completion, screening "positive", and subsequent diagnosis of depression were reported overall; by age, gender, race/ethnicity, and estimated household income with Poisson regression comparing rates across subgroups. RESULTS: Among the adolescents, 613,662 (81.6 %) had primary care visits, of these, 403,890 (65.8 %) completed at least one screening during the study period. Although statistically significant, screening rates were generally comparable across age, gender, household income and race/ethnicity. A total of 9.7 % adolescents screened "positive", with some differences within subgroups. Among adolescents with "positive" screening, 30.2 % were diagnosed with depression within two years after the first "positive" screening, with some differences within subgroups. Adolescents self-identified as other gender had substantially higher rate of "positive" screening and diagnosis rate; however, the data was based on a sample size less than 50. CONCLUSION: Depression screening can be administered at primary care for adolescents starting as early as age 11 years old. Screening with PHQ at primary care as part of standard preventive care can effectively identify adolescents at risk for depression.

BACKGROUND: A fully integrated Obstetric Mental Health Clinic (OBMHC) was established in 2007 in the rural northwest United States to address perinatal depression. AIMS: The purpose of this mixed methods study was to examine depression outcomes in women receiving outpatient psychiatric services between 2007 and 2017 at a fully integrated OBMHC and to explore patient and obstetric team perceptions of OBMHC experiences. METHOD: A retrospective database study was employed; depression was measured at baseline and follow-up visits using the Edinburgh Postnatal Depression Scale. Descriptive statistics, regression models, and trend analysis were employed to determine effectiveness. A subset of patients participated in telephone interviews; the obstetric team was surveyed regarding perceptions of the service. RESULTS: The sample included 192 women (195 pregnancies). Approximately 72% experienced less depression by the first follow-up visit. Patients taking three or more psychiatric medications attended more OBMHC visits. Trend analysis indicated that women with the highest levels of depression had the best response to the intervention. Three qualitative themes emerged: Safe Place, Mental/Emotional Stability, and Integrated Personalized Approach. Obstetric team members (n = 11) perceived the clinic to be helpful and noted improved access to mental health care. CONCLUSION: OBMHCs can be effective when psychiatric nurses are embedded within an outpatient obstetric service. Improved access, timely services, and patient reassurance can lead to an improved pregnancy experience and reduced depressive symptoms. The longevity of this clinic's experience serves as a role model for other centers to replicate this successful integrated model of care.