Universal school-based screening for major depressive disorder (MDD) in high school increases the likelihood that students with MDD will begin treatment, a study published today in JAMA Network Open suggests.
Deepa L. Sekhar, M.D., M.Sc., of Pennsylvania State College School of Medicine and colleagues analyzed data from 12,909 students in 14 Pennsylvania high schools who were randomized to either targeted screening or universal screening for MDD between November 2018 and November 2020. Targeted screening followed current school practice; if a student exhibited behaviors suggestive of MDD, a referral was made to the Student Assistance Program—a team of school staff and liaisons from mental health agencies. Universal screening involved students completing the nine-item Patient Health Questionnaire (PHQ-9). Students with a PHQ-9 score above 10; 1 or greater on Question 9 of the PHQ-9 (suicidal thoughts or self-harm); and/or displaying MDD behaviors were referred to the Student Assistance Program.
Compared with students in the targeted screening group, students in the universal screening group had 5.92 times higher odds of being identified with MDD symptoms, 3.30 times higher odds of their Student Assistant Program confirming that they had symptoms and needed treatment, and 2.07 times higher odds of beginning treatment. Overall, 9.5% of students had MDD symptoms. Of those, 15.9% in the universal screening group had MDD symptoms, compared with 3.1% in the targeted screening group.
“The results of this [study] support that universal adolescent MDD screening conducted in a school system can successfully identify students who would not otherwise be detected, with increased odds of treatment initiation among identified students,” Sekhar and colleagues wrote. “Future work should identify the barriers to school participation in universal screening and the means to overcome them, including an economic and resource analysis in partnership with policymakers, schools, and parents to consider the most effective means for implementation nationally.”
For related information, see the Psychiatric Services article “Schools As a Vital Component of the Child and Adolescent Mental Health System.”
(Image: iStock/Vladimir Vladimirov)
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