Doctors in the United States and Canada are increasingly encouraged to try to identify depression in children and adolescents, even when there are no obvious indications that it exists.
Physicians often use short questionnaires that ask about symptoms of depression. But, new research suggests there is insufficient evidence to show that these surveys accurately screen 6- to 18-year-olds for the disease, calling into question the use of these tools for children and raising worries about possible misdiagnosis.
“Our study shows that if depression screening were carried out using existing screening tools, many non-depressed children and adolescents would be mistakenly identified as depressed,”
says Brett Thombs, who is affiliated with the Jewish General Hospital’s Lady Davis Institute for Medical Research and McGill University’s Faculty of Medicine.
Only Seventeen Studies
In order to assess the quality of the screening tools that are currently used to identify depression in children or adolescents, researchers looked for studies that put the screening tools to the test. They were able to identify just 17 studies where the test results from the screening tools were compared with results from a diagnostic interview to determine if the children or adolescents in the study actually had depression.
The researchers then assessed the methodology and results of the 17 studies and found that most were too small to make a valid determination about the accuracy of the screening tools and that the methods of most studies fell short of expected standards.
They also found that there was inadequate evidence to recommend any single cut-off score for any of the questionnaires. Patients scoring above a pre-defined cut-off score are considered likely to be depressed, while patients below the cutoff are not.
“There was not a single tool with even moderate evidence of sufficient accuracy to effectively identify depressed children and adolescents without also incorrectly picking up many non-depressed children and adolescents,” says lead author Michelle Roseman.
Depression in children is a disabling condition associated with behavioral problems and poor school performance. But routine screening is controversial. In the United Kingdom and Canada it is not recommended.
The US Preventative Services Task Force recently recommended routine screening of adolescents between 13-18, but not of younger children, as part of regular medical care.
Given the inaccuracy of the tools currently being used, some children could end up mislabeled as depressed, Thombs says.
“This could lead to the unnecessary prescription of potentially harmful psychiatric medications and negative messages about the mental health of some children who do not have mental health disorders.”
Moreover, a potentially massive amount of resources would be needed to sort out which children may really be depressed. Research suggests relatively few would meet the criteria.
“These resources would then not be available to provide treatment to large numbers of children and adolescents who are known to have severe mental health problems, but who do not receive adequate care,” Thombs says.
To properly assess the accuracy of depression screening tools in children, large, well-designed studies that present results across a range of cut-off scores are needed, the authors conclude.
The study was funded by the Canadian Institutes of Health Research, the Arthritis Society, the Mach-Gaensslen Foundation of Canada, and a Murray R. Stalker Primary Care Research Bursary.
Michelle Roseman, Lorie A. Kloda, Nazanin Saadat, Kira E. Riehm, Abel Ickowicz, Franziska Baltzer, Laurence Y. Katz, Scott B. Patten, Cécile Rousseau, and Brett D. Thombs
Accuracy of Depression Screening Tools to Detect Major Depression in Children and Adolescents: A Systematic Review
Can J Psychiatry 0706743716651833, first published on May 27, 2016 doi:10.1177/0706743716651833