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

Project Number: R40MC31765
Grantee: Pennsylvania State University, The
Department/Center: College of Medicine
Project Date: 07/01/2018
Principal Investigator: Deepa Sekhar

Final Report

Pending

Age

• Adolescence (12-18 years)

Targeted/Underserved Population

• African American
• Hispanic/Latino
• Low-income
• Rural

Abstract

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.

Publications

Listed is descending order by year published.

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.