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Depression in adolescents is a disabling condition associated with long term mental and physical health issues. Screening is seen as one of the best ways to identify and improve depression management (Roseman et al., 2017). In the United States, 11.4% of adolescents have been diagnosed with depression annually and suicide was stated to be the 3rd leading cause of their death (Leslie et al., 2018). Depression is a commonly reoccurring, seriously impairing, mental problem and the World Health Organization grades major depressive problem as the fourth leading cause of mental disability (Kessler, 2012). Adolescent depression is a growing public health concern (Dihigo, 2015) and should be given a great consideration. Depression has both individual effects as well as economic and social consequences (De Jonge-Heesen et al., 2016). Adolescent depression causes later role transitions difficulties, including low educational accomplishments, high risk of adolescent childbearing, marital disturbances, poor health and unsteady employment (Kessle, 2012). Wright. (2015) indicated that children who were diagnosed with depression, anxiety, and other emotional disorders had yearly health care expenses of $2237, higher than that of children with a physical illness like asthma or diabetes.
In 2003, the health cost for the treatment of depression was 660 million euros in the Netherlands and 773 million in Dutch in 2005 (De Jonge-Heesen et al., 2016). In general, mental health disorders are considered to take a huge part in medical spending ($8.9 billion) when compared with other health disorders that contribute to overall child health expenditures (Ghandour et al., 2020). The rate of admission of children with the mental diagnosis was noted to be 5.5 per 1,000 children in the U.S. population, with 2.9 having depression as the main diagnosis (Egorova,2018). Depression is the most frequent mental diagnosis in children, and it accounts for up to 44.1% of mental health admissions seen in children and adolescents. It costs the United States healthcare system up to $1.33 billion per year (Melnyk, 2020). The economic burden of major depressive disorder is estimated at $210.5 billion per year With the huge effect of depression both on the individual, family, and society, it is worth the implementation of quick measures on the part of health professionals in the identification, referral, and treatment of adolescent depression. This will help in the reduction of long-term disabilities associated with depression and reduced health costs.
The Patient Health Questionnaire-9 (PHQ-9) screening tool is ridiculously cheap. The cost of printing a copy of PHQ 9 paper is about $0.20 and use of a nurse practitioner with an hourly pay of $75 and a medical assistant for $15 per hour. PHQ 9 is a reliable, valid, and cost-effective psychological screening tool for depression and can be reproduced by any provider without any implication of copyright violation (Fisher, 2020). Most clinics and hospitals have PHQ 9 questionnaire installed in their EMR that often time, one does not need to print it thereby reducing the printing cost. The benefit of screening these teens cannot be overemphasized. The utilization of PHQ 9 tool in screening for depressive symptoms in this population will lead to early referrals and treatment, therefore reducing the health cost of their treatment. There will be a saving of up to $765, 5 00, reduction in hospitalization visit if these teens are identified early, referred, or treated in a 12-week screening if it causes $4500 per a patient with depression to be hospitalized in 5 days. The collaborative care of all clinician in screening these teens is very cost effective and will not only increase the treatment but have a significant effect in their quality of life (Wright et al, 2016).
References
De Jonge-Heesen, K. W. J., Van Ettekoven, K. M., Rasing, S. P. A., Oprins-van Liempd, F. H.,
Vermulst, A. A., Engels, R. C. M. E., & Creemers, D. H. M. (2016). Evaluation of a school-based depression prevention program among adolescents with elevated depressive symptoms: study protocol of a randomized controlled trial. BMC Psychiatry, 16, 1–9. Retrieved from https://doi-org.libproxy.chapman.edu/10.1186/s12888-016-1119-8
Dihigo, S. K. (2014). Use of screening tools for depression in adolescents: An evidence-based
systematic review. Women’s Healthcare: A Clinical Journal for NPs, 2(2), 23–30.
Egorova, N. N., Pincus, H. A., Shemesh, E., & Kleinman, L. C. (2018). Behavioral Health
Diagnoses Among Children and Adolescents Hospitalized in the United States: Observations and Implications. Psychiatric Services, 69(8), 910–918. Retrieved from https://doi-org.libproxy.chapman.edu/10.1176/appi.ps.201700389
Fisher, C. (2020). Patient Health Questionnaire – 9 Is an Excellent Free Psychological
Screening Instrument for Depression. Retrieved from: https://www.bmedreport.com/archives/14638.
Kessler R. C. (2012). The costs of depression. The Psychiatric clinics of North America, 35(1),
1–14. Retrieved from https://doi.org/10.1016/j.psc.2011.11.005
Ghandour, R. M., Sherman, L. J., Vladutiu, C. J., Ali, M. M., Lynch, S. E., Bitsko, R. H., &
Blumberg, S. J. (n.d.). Prevalence and Treatment of Depression, Anxiety, and Conduct Problems in US Children. JOURNAL OF PEDIATRICS, 206, 256–+. Retrieved from https://doi-org.libproxy.chapman.edu/10.1016/j.jpeds.2018.09.021
Leslie, K. R., & Chike-Harris, K. (2018). Patient-Administered Screening Tool May Improve
Detection and Diagnosis of Depression Among Adolescents. Clinical Pediatrics, (4), 457. Retrieved from http://search.ebscohost.com.libproxy.chapman.edu/login.aspx?direct=true&AuthType=ip,uid&db=edsbl&AN=RN615240200&site=eds-live
Melnyk, B. M. (2020). Reducing Healthcare Costs for Mental Health Hospitalizations With the
Evidence-based COPE Program for Child and Adolescent Depression and Anxiety: A Cost Analysis. Journal of Pediatric Health Care, 2, 117.
Roseman, M., Saadat, N., Riehm, K. E., Kloda, L. A., Boruff, J., Ickowicz, A., Baltzer, F., Katz,
- Y., Patten, S. B., Rousseau, C., & Thombs, B. D. (2017). Depression screening and health outcomes in children and adolescents: A systematic review. The Canadian Journal of Psychiatry / La Revue Canadienne de Psychiatrie, 62(12), 813–817. Retrieved from https://doi-org.libproxy.chapman.edu/10.1177/0706743717727243
Russo, C. A., Hambrick, M. M., & Owens, P. L. (2006). Hospital Stays Related to Depression,
2005: Statistical Brief #40.
Wright, D. R., Haaland, W. L., Ludman, E., McCauley, E., Lindenbaum, J., & Richardson, L. P.
(2016). The Costs and Cost-effectiveness of Collaborative Care for Adolescents with Depression in Primary Care Settings: A Randomized Clinical Trial. JAMA Pediatrics, 170(11), 1048–1054. https://doi-org.libproxy.chapman.edu/10.1001/jamapediatrics.2016.1721
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Hello Omukama,
Thank you for the comprehensive post on the impact of adolescent depression and the need for its early identification. Depressive disorders are one of the leading causes of death and disability globally. According to Keiling et al., (2019), to a large extent, the negative impacts of depressive disorders are attributed to its peak incidence in late childhood and adolescents and its chronicity in life. Several interventions aiming to mitigate the effects of depression have been developed and instituted. However, most interventions demonstrated limited efficacy to identify and treat adolescent depression (Cipriani et al., 2016). For instance, universal approaches using school-based mental interventions have been largely implemented. Despite initial anticipations that such interventions would reduce the burden associated with depression, large trials demonstrated limited efficacy for the prevention of childhood and adolescent depression (Keiling et al., 2019). Therefore, it is essential to invest in preventive strategies to mitigate the burden of childhood and adolescent depression. This would ensure a reduction in the burden during critical developmental phases and across the lifespan (Keiling et al., 2019). Interventions tailored to meeting the specific needs of adolescents must be formulated and implemented to ensure cost-effective care and safe patient outcomes.
References
Cipriani, A., Zhou, X., Del Giovane, C., Hetrick, S. E., Qin, B., Whittington, C., … & Cuijpers, P. (2016). Comparative efficacy and tolerability of antidepressants for major depressive disorder in children and adolescents: a network meta-analysis. The Lancet, 388(10047), 881-890.https://doi.org/10.1016/S0140-6736(16)30385-3
Kieling, C., Adewuya, A., Fisher, H. L., Karmacharya, R., Kohrt, B. A., Swartz, J. R., & Mondelli, V. (2019). Identifying depression early in adolescence. The Lancet Child & Adolescent Health, 3(4), 211-213. https:// doi: 10.1016/S2352-4642(19)30059-8