title: Predictors of persistence after a positive depression screen among adolescents.
abstract: OBJECTIVE
  To examine predictors of depression persistence after a positive screening test to inform management protocols for screened youth.
  
  
  METHODS
  We conducted a cohort study of 444 youth (aged 13-17 years) from a large health care delivery system. Youth with depressive symptoms, based on a 2-item depression screen, were oversampled for the baseline interview. Baseline assessments included the Patient Health Questionnaire 9-item (PHQ-9) depression screen as well as clinical factors that were hypothesized to influence depression persistence (family history of depression, functional impairment, perceived social support, anxiety symptoms, externalizing symptoms, and medical comorbidity). Logistic regression analysis was used to examine factors associated with the persistence of depression at 6 months postbaseline.
  
  
  RESULTS
  Of 113 youth with a positive baseline screen (PHQ-9 ≥11), 47% and 35% continued to be positive at 6-week and 6-month follow-up, respectively. After controlling for treatment status, only 2 factors were significantly associated with depression persistence at 6 months: baseline depressive symptom score and continuing to have a positive screen at 6 weeks. For each 1-point increase on the PHQ-9 score at baseline, youth had a 16% increased odds of continuing to be depressed at 6 months (odds ratio: 1.16, 95% confidence interval: 1.01-1.34). Youth who continued to screen positive 6 weeks later had almost 3 times the odds of being depressed at 6 months (odds ratio: 2.89, 95% confidence interval: 1.09-7.61).
  
  
  CONCLUSIONS
  Depressive symptom severity at presentation and continued symptoms at 6 weeks postscreening are the strongest predictors of depression persistence. Patients with high depressive symptom scores and continued symptoms at 6 weeks should receive active treatment.
authors.affiliation: Departments of Pediatrics, University of Washington School of Medicine, Seattle, WA 98121, USA. laura.richardson@seattlechildrens.org
authors.forename: Laura P
authors.initials: LP
authors.lastname: Richardson
authors.forename: Elizabeth
authors.initials: E
authors.lastname: McCauley
authors.forename: Carolyn A
authors.initials: CA
authors.lastname: McCarty
authors.forename: David C
authors.initials: DC
authors.lastname: Grossman
authors.forename: Mon
authors.initials: M
authors.lastname: Myaing
authors.forename: Chuan
authors.initials: C
authors.lastname: Zhou
authors.forename: Julie
authors.initials: J
authors.lastname: Richards
authors.forename: Carol
authors.initials: C
authors.lastname: Rockhill
authors.forename: Wayne
authors.initials: W
authors.lastname: Katon
mesh_terms: D000293:Adolescent; D002908:Chronic Disease; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D003866:Depressive Disorder / Q000175:diagnosis* / Q000453:epidemiology* / Q000628:therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008403:Mass Screening; D011320:Primary Health Care; D012075:Remission, Spontaneous; D012307:Risk Factors; D011795:Surveys and Questionnaires; D014861:Washington; D057832:Watchful Waiting