Depression Screening in Adolescents with Type 1 Diabetes Mellitus

Abstract

Background: Adolescents with type 1 diabetes mellitus (T1D) are at increased risk for depressive symptoms relative to youth without diabetes, which is associated with poor diabetes outcomes (Hood et al, 2014). As part of ongoing Quality Improvement initiatives at Texas Children’s Hospital (TCH), we evaluated two validated depression screening measures, the PHQ-2 and PHQ-9: Modified for Teens, to standardize our depression screening process. Objectives: We sought to (1) review screening outcomes from youth with T1D who completed both the PHQ-2 and PHQ-9, (2) determine which measure provided the greatest sensitivity to identifying depressive symptoms, and (3) create a standardized process for implementation of the more sensitive screen. Methods: Data was collected by a chart review of PHQ-2 and PHQ-9 scores for all patients with T1D age 12-17 seen at TCH Endocrine clinic sites between January 1 –December 31, 2017. A positive screen was defined as PHQ-2 score ≥ 3 and PHQ-9 score ≥ 5. We then created an algorithm based on the more sensitive screen for referrals to mental health services. Results: Of 961 eligible patients, 84% were screened using PHQ-2 and 15% using both the PHQ-2 and PHQ-9. Of the patients who completed both measures, the positive screening rate was 20% in PHQ-9 vs. 4% in PHQ-2. None of the patients with “moderate” PHQ-9 (≥5-9) screened positive on the PHQ-2, and only 1 patient with “severe” PHQ-9 (≥10) score screened positive on PHQ-2. Of the 3 patients who endorsed suicidality on the PHQ-9, none had a positive PHQ-2. 80% of patients who received both screens completed the screens within 2 months of each other. Discussion: PHQ-2 depression screen may be less sensitive than PHQ-9 for capturing depressive symptoms in youth with T1D. We have created a standardized algorithm implementing PHQ-9 into the clinic flow and looking at optimizing mental health referrals. Hood KK, Lawrence JM, Anderson A, Bell R, et al. Metabolic and inflammatory links to depression in youth with diabetes. Diabetes Care 2012;35:2443-2446. Disclosure G.K. Kim: None. S. Relan: None. M. Tosur: None. S. Agarwal: None. I. Jindal: None. T. Patel Moorjani: None. K. Fegan-Bohm: None. K.A. Gallagher: None. K. Hendrix: None.