Depression and Anxiety Screening PowerPoint for UCAYA

1. Screening for Depression and
Anxiety in Our Youth
Mike Guyton, MD
Assistant Clinical Professor/Academic
Faculty in General Pediatrics

2. Objectives
• Current burden of mental illness among
youth
• Impact of early recognition
• Introduction of screening tools used at
CPM
– PHQ-9 Screen for Depression
– SCARED Questionnaire for Anxiety

3. Current Burden of Mental Illness
Among Youth
• Depression
– Point prevalence in those 4-17yo estimated to be 3-3.5%
– Lifetime prevalence as high as 7-8%
• Relapse as high as 40% in 2 years
– F:M 2:1; increased risk to those born in latter half of 20th century
• Anxiety
– Usually co-morbid with depression
• Estimated to be current in ~3% of those 3-17yo
• Suicide
– 3rd leading cause of death among all children and adolescents in
the US
– In 2010, rates estimated to be 4.5/100,000 youth 10-19yo
– Overall, rates of pediatric suicide are increasing

4. Pediatric Suicides
• Suicidal Ideation (SI)  Suicide Attempt  Completed
Suicide
– Of those with SI, ~34 percent attempt
– 50-100 attempts for every completed suicide
• Several Mechanisms Used
– Hanging/Suffocation and Firearms most common among
adolescents
• Patterns discovered based on retrospective studies
– 29.5% disclosed intent prior to suicide
– 35.5% with a diagnosed mental illness at time of suicide
– 26.4% were undergoing treatment at time of suicide
– 21.1% had a previous attempt at time of successful suicide

5. Impact of Early Recognition
• Concern that talking/asking about mental
illness/suicide will initiate suicidal
actions/ideation
– NOT supported by the medical literature and
evidence
• Long term consequences of co-morbid
mood/anxiety disorders
– Poor psychosocial functioning
– Lower educational attainment
– Impaired functioning in multiple domains
• Work, family, and parenting

6. What Makes Identification Tough
• Kids/Adolescents have many reasons to hide
their feelings of depression/anxiety
– Fear of Stigma
– Belief that depression is not treatable by primary
care docs
– Depression is not a “real” illness, but instead a
personal flaw
– Concerns about confidentiality
– Do not want medication or involvement of a
psychiatrist

7. Screening for Depression and
Suicide: The PHQ-9
• Multipurpose instrument for screening, diagnosing,
monitoring, and measuring depression severity
• Completed by the patient
– Validity decreased if completed by a guardian or
parent
• Diagnostic validity established in studies from
Primary Care and Obstetric clinics
• Scores > or = to 10 had a Sensitivity and
Specificity of 88% for Major Depression
– Sensitivity: Helps to rule out disease (SNOUT)
– Specificity: Helps to rule in disease (SPIN)

8. The Questionnaire

9. Scoring

10. Screening for Anxiety: The
SCARED Questionnaire
• Screens for the presence of Anxiety
– Self-Report for Childhood Anxiety Related Disorders
• Used to detect clinically significant anxiety problems in children
and adolescents
• Indicates answers that could represent a particular
form of anxiety
– Panic Disorder/Somatic Symptoms
– Generalized Anxiety Disorder
– Separation Anxiety
– Social Anxiety
– School Avoidance
• Given to both child and the parent
– May be read aloud for the child when given

11. The Questionnaire

12. Scoring of SCARED

13. Utility in the School Setting
• Both Tools are easily available for teachers
and staff to use
• Caveat: “Next Step” in care needs to be
identified and streamlined
– Referral to school social worker
– Review of academic stressors and responsibilities
• Best Initial Step: Encourage patient and
parents to speak with their physician
regarding concerns

14. Questions?