Effectiveness of Universal School-Based Screening vs Targeted Screening for Major Depressive Disorder Among Adolescents

Abstract

Key PointsQuestionIs universal school-based screening for adolescent major depressive disorder (MDD) more effective than the existing process of targeted screening based on observable behaviors of concern?FindingsScreening in High Schools to Identify, Evaluate, and Lower Depression (SHIELD) is a randomized clinical trial that will take place in at least 8 public senior high schools in Pennsylvania to evaluate the effectiveness of universal screening for identifying MDD and engaging students with resources.MeaningThe SHIELD trial directly addresses the US Preventive Services Task Force call for large, high-quality randomized clinical trials to better understand the effects of MDD screening and quantify the proportion of adolescents with screen-detected MDD successfully referred and treated.

Screening in High Schools to Identify, Evaluate, and Lower Depression Among Adolescents

“…26 The sample size had greater than 80% power for planned subgroup analyses by sex and race and ethnicity to understand the effectiveness of screening on disparities in MDD identification and treatment initiation. 8 Demographic data were based on school records.…”

“…Schools were randomized to either (1) 9th and 11th graders assigned to universal screening, or (2) 10th and 12th graders assigned to universal screening, with the other grades assigned to targeted screening. 8 School students and staff were not blinded to study group. All 9th-to 12th-grade students were eligible for participation aside from those whose parents opted out or students with disabilities deemed unable to participate by the school.…”

“…Letters sent to parents or guardians before screening detailed the project and screening instrument, the Patient Health Questionnaire-9 (PHQ-9), and offered the opportunity to opt their student out of the study. 8,21 Students in the universal screening group either gave their assent by completion of the PHQ-9 or their refusal by declining to complete it at the time of screening.…”

“…Thus, we identified schools as an ideal setting to (1) evaluate universal adolescent MDD symptom screening, (2) compare the effectiveness of universal vs targeted MDD symptom screening, and (3) address disparities in MDD screening. 8 Prior studies of school-based MDD screening demonstrate increased identification and referral, but limited data exist on treatment initiation. [9][10][11][12] An RCT by Huskey et al 13 of 4 Pennsylvania high schools demonstrated increased treatment initiation with screening.…”

“…Schools create a more equitable setting for screening given that most adolescents attend, regardless of race, ethnicity, and socioeconomic status. Thus, we identified schools as an ideal setting to (1) evaluate universal adolescent MDD symptom screening, (2) compare the effectiveness of universal vs targeted MDD symptom screening, and (3) address disparities in MDD screening . Prior studies of school-based MDD screening demonstrate increased identification and referral, but limited data exist on treatment initiation .…”