Screening, Brief Intervention, and Referral to Treatment for Adolescent Depression in Primary Care

Pre-pandemic, suicide was the second leading cause of death among teens and young adults, aged 15 to 24 years; in 2019, more than one-third of high-school students aged 14-17 years reported persistent feelings of sadness and hopelessness, with nearly 20% of those individuals seriously considering suicide; and post-pandemic, the suicide rate among adolescents, aged 12 to 18 years, is rising. Of further note, 40% of adolescents who died by suicide had seen a medical provider in the month before their death. The problem identified by this project was pediatric primary care providers (PCPs) are spending more than half their day supporting adolescent and teen patients with mental health needs during a period of rapid physical, emotional, and social development despite having limited mental health training. This issue is further complicated by a lack of access to behavioral health specialists. The project was designed to guide pediatric PCPs and their care teams with early identification of depression among adolescents aged 12 to 18 years, early intervention for positive depression screening, and reduction of suicide risk through 6-8 weeks of active monitoring of the adolescent in the primary care setting. To accomplish this task, a screening, brief intervention, and referral to treatment (SBIRT) toolkit was developed utilizing evidence presented in the 2018 Guidelines for Adolescent Depression in Primary Care (GLAD-PC); and it took into consideration the challenges faced by PCPs when selecting a screening tool and the burden of treatment, time, and accountability related to identification of a positive depression screen. The toolkit contains the 9-item patient health questionnaire (PHQ-9) modified for teens to be utilized as the self-assessment tool; the brief intervention tool, which guides the clinician through non-judgmental interpretation of screening results, further assessment of at-risk behaviors, and safety planning; and a referral to treatment infographic to be provided to the patient/patient’s family with a list of community supports and crisis resources. The SBIRT toolkit was evaluated by five family nurse practitioner (FNP) reviewers. Quantitative feedback showed at least 60% of reviewers were “very likely,” with remaining 40% “moderately likely,” to use the screening and brief intervention tools in clinical practice. Qualitative feedback supported the use of the referral to treatment tool for its depth of resources. Consequently, the SBIRT toolkit may be a viable option to support pediatric PCPs with early identification of adolescent depression while providing compassionate support to the adolescent patient and their family when a positive screen is identified. The goal is to reduce suicide risk through brief intervention and active monitoring of the adolescent patient by the primary care team. The SBIRT toolkit offers a cost-effective and sustainable option for pediatric PCPs to address a healthcare gap in access to behavioral health providers and improve health outcomes for adolescents aged 12 to 18 years who are at risk for depression and suicide.