Inaccurate depression screening tools used for children and adolescents

Researchers from McGill University found that commonly used screening tools are not accurately identifying depression in adolescents and children.

Screening tools are used to identify the presence of a disorder in someone who has not otherwise been diagnosed with the disorder, Brett Thombs explains. Thombs is the senior author of the study, and is affiliated with the Jewish General Hospital’s Lady Davis Institute for Medical Research and McGill University’s Faculty of Medicine.

“We’re not talking about people who are coming for help or people who think they might have a mental health problem,” says Thombs. “It’s people who think they don’t, they think everything’s going okay, and we’re going to give them a test.”

Identifying adolescents who need mental health care and connecting them with appropriate resources is a difficult task. Screening has been suggested as a tool that can facilitate the process, but Thombs says that clinicians need to be careful when deciding whether it is actually a solution to the problem.

The research conducted by Thombs and his colleagues evaluated the testing of screening tools for depression in adolescents, and the accuracy of screening tools at screening adolescents with depression. They found only 17 studies that both tested screening tools and compared the results of these tools with diagnostic interviews to find out if the adolescents or children actually had depression.

“Studies that exist are very small studies that don’t meet the standards of what we expect from diagnostic studies. So the estimates they’re making are so disparate that we don’t really know what to do with them,” says Thombs.

But even studies that included more patients showed that the outcomes of screening tools are not accurate for adolescents. One study that Thombs and the team looked at evaluated the accuracy of PHQ-9, one screening tool recommended by the U.S. Preventative Services Task Force for adolescents, ages 13 to 18. The results of the study showed that out of all the children who did not have depression in the study, this screening tool identified 22 per cent of them incorrectly as having depression.

“If you’re not bringing the right kids in, you’re labelling kids unnecessarily or you’re labelling kids improperly and I think we need to recognize mental health problems when they’re there, but we also need to avoid labelling people or suggesting they’re having problems when they actually are coping with them okay.”

Screening tools are not currently recommended for adolescents in the United Kingdom and Canada. “There’s never been any evidence that screening actually works very well,” says Thombs.

Adolescents could be unnecessarily receiving potentially harmful medications for a disorder they don’t have as a result of false screening tool outcomes. This mislabelling also puts pressure on an already limited depression treatment resource pool.

Thombs and his colleagues are hoping to publish new research next year that will help to better calibrate the currently used screening tools. They plan to create an application that will consider the screening tool scores, along with variables like gender, family health history and age to more accurately screen for disorders like depression.