title: Improving depression screening for adolescents with type 1 diabetes.
abstract: OBJECTIVE
  Depression is common among adolescents, but rates increase significantly in the presence of chronic health conditions. Outpatient screening for depression is recommended but rarely formally conducted due to barriers of implementation.
  
  
  METHODS
  To provide a model for depression screening of youth with chronic health conditions, a standard process using a self-administered electronic version of the Children's Depression Inventory (CDI) was developed. Quality improvement methodology and traditional analytic approaches were used to test the feasibility and outcomes of routine screening in patients 13 to 17 years of age with type 1 diabetes.
  
  
  RESULTS
  Of the 528 eligible adolescents, 509 (96%) received at least 1 depression screen during the first year. The process was tested and refined in over 1200 patient encounters, which resulted in an increase in depression screening rates from <5% to a median of 85% over the initial 12 months. Both patients and staff reported acceptance of screening on qualitative surveys. Elevated CDI scores (≥ 16) were found in 8% of the sample; moderate scores (10-15) in 12% of the sample. Low risk scores were found in 80% of the sample. Higher CDI scores correlated with lower blood glucose monitoring frequency and higher hemoglobin A1c, confirming the link between more depression symptoms and poorer diabetes management and control. Suicidal ideation was endorsed in 7% of the population.
  
  
  CONCLUSIONS
  Systematic depression screening in adolescents with type 1 diabetes can be reliably implemented with clinically significant results. A systematic approach, such as described in this study, can serve as a model for other chronic health conditions.
authors.affiliation: Division of Endocrinology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, MLC7012, Cincinnati, OH 45219. sarah.corathers@cchmc.org.
authors.forename: Sarah D
authors.initials: SD
authors.lastname: Corathers
authors.forename: Jessica
authors.initials: J
authors.lastname: Kichler
authors.forename: Nana-Hawa Yayah
authors.initials: NH
authors.lastname: Jones
authors.forename: Andrea
authors.initials: A
authors.lastname: Houchen
authors.forename: Mary
authors.initials: M
authors.lastname: Jolly
authors.forename: Nancy
authors.initials: N
authors.lastname: Morwessel
authors.forename: Peggy
authors.initials: P
authors.lastname: Crawford
authors.forename: Lawrence M
authors.initials: LM
authors.lastname: Dolan
authors.forename: Korey K
authors.initials: KK
authors.lastname: Hood
mesh_terms: D000293:Adolescent; D003863:Depression / Q000175:diagnosis* / Q000453:epidemiology* / Q000523:psychology; D003922:Diabetes Mellitus, Type 1 / Q000175:diagnosis* / Q000453:epidemiology* / Q000523:psychology; D005260:Female; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000379:methods / Q000592:standards*; D011795:Surveys and Questionnaires / Q000592:standards*
keywords: adolescent depression; chronic conditions; quality improvement; type 1 diabetes