(FIRST) Randomized Control Trial of Universal vs. Targeted School Screening for Adolescent Major Depressive Disorder

The prevalence of annual major depressive disorder (MDD) episodes has increased by greater than 50% from 2008 to 2015 among US adolescents. Paralleling the rise in MDD suicide is now the 2nd leading cause of adolescent deaths. Despite the US Preventive Services Task Force (USPSTF) 2009 endorsement of universal screening for adolescent MDD in primary care MDD screening occurs in less than 2% of office visits. Further screening is 80% less likely for Hispanic compared to non-Hispanic White adolescents and both minorities and females are less likely to receive MDD treatment. The primary goal of the proposed study is to compare the effectiveness of universal versus targeted adolescent MDD screening in a school setting. Universal screening was chosen to be conducted in schools because compared to medical settings; schools are more likely to engage adolescents representing a broad spectrum of race ethnicity and socioeconomic status. Our hypothesis is that universal school-based screening with the validated Patient Health Questionnaire (PHQ) will result in increased rates of MDD identification and treatment engagement and reduce disparities by race ethnicity and sex in adolescent mental health. Our Penn State team brings a breadth of experience in pediatrics community-engaged research adolescent health psychiatry and engagement with minority populations. We have actively partnered with school staff parents and adolescents in designing a randomized controlled trial with 8 Pennsylvania public high schools (letters of commitment obtained) serving an estimated 9 650 predominantly minority rural and/or low socioeconomic status 9th -12th grade students to conduct the proposed research. Our long-term goal is to improve adolescent mental health and reduce the sequelae of MDD (e.g. suicide academic failure). The results of this trial are anticipated to inform the evidence in support of universal screening to improve MDD identification and treatment engagement thus reducing the prevalence of youth suffering from MDD episodes a Healthy People 2020 Leading Indicator. The proposal addresses MCH Block Grant National Performance Domain No. 9 - Adolescent preventive services. We have incorporated all four MCHB Strategic Research Issues: (I) improve the health infrastructure and systems of care (II) eliminate health barriers and disparities (III) assure quality of care and (IV) promote an environment that supports maternal and child health. Mental health is also a clinical priority of the U.S. Department of Health and Human Services' (HHS). Finally by engaging with schools and using data routinely collected by the Pennsylvania Student Assistance Program we will consider a unique strategy to meet the USPSTF recommendation of universal screening for adolescent MDD.

Sekhar DL, Pattison KL, Confair A, Molinari A, Schaefer EW, Waxmonsky JG, Walker-Harding LR, Rosen P, Kraschnewski JL. Effectiveness of universal school-based screening vs. targeted screening for major depressive disorder among adolescents: a trial protocol for the Screening in High Schools to Identify, Evaluate, and Lower Depression (SHIELD) randomized clinical trial. JAMA Netw Open. 2019; Nov 1;2(11):e1914427. DOI:10.1001/jamanetworkopen.2019.14427 November 2019 31675086 JAMA Netw Open

Stephens SB, Raphael JL, Zimmerman CT, et al. The utility of self-determination theory in predicting transition readiness in adolescents with special healthcare needs. J Adolesc Health. Published online May 28, 2021. DOI:doi:10.1016/j.jadohealth.2021.04.004 May 2021