title: Association of Adolescent Depressive Symptoms With Health Care Utilization and Payer-Incurred Expenditures.
abstract: OBJECTIVE
  Screening adolescents for depression is recommended by the US Preventive Services Task Force. We sought to evaluate the impact of positive depression screens in an adolescent population on health care utilization and costs from a payer perspective.
  
  
  METHODS
  We conducted depression screening among 13- to 17-year-old adolescents enrolled in a large integrated care system using the 2- and 9-item Patient Health Questionnaires (PHQ). Health care utilization and cost data were obtained from administrative records. Chi-square, Wilcoxon rank sum, and t tests were used to test for statistical differences in outcomes between adolescents on the basis of screening status.
  
  
  RESULTS
  Of the 4010 adolescents who completed depression screening, 3707 (92.4%) screened negative (PHQ-2 <2 or PHQ-9 <10), 186 (3.9%) screened positive for mild depression (PHQ-9 10-14), and 95 (2.4%) screened positive for moderate to severe depression (PHQ-9 ≥15). In the 12 months after screening, screen-positive adolescents were more likely than screen-negative adolescents to receive any emergency department visit or inpatient hospitalization, and they had significantly higher utilization of outpatient medical (mean ± SD, 8.3 ± 1.5 vs 3.5 ± 5.1) and mental health (3.8 ± 9.3 vs 0.7 ± 3.5) visits. Total health care system costs for screen-positive adolescents ($5083 ± $10,489) were more than twice as high as those of screen-negative adolescents ($2357 ± $7621).
  
  
  CONCLUSIONS
  Adolescent depressive symptoms, even when mild, are associated with increased health care utilization and costs. Only a minority of the increased costs is attributable to mental health care. Implementing depression screening and evidence-based mental health services may help to better control health care costs among screen-positive adolescents.
authors.affiliation: Department of Pediatrics, University of Washington School of Medicine, Seattle, Wash; Seattle Children's Research Institute Center for Child Health, Behavior, and Development, Seattle, Wash. Electronic address: Davene.Wright@seattlechildrens.org.
authors.forename: Davene R
authors.initials: DR
authors.lastname: Wright
authors.affiliation: Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, Wash.
authors.forename: Wayne J
authors.initials: WJ
authors.lastname: Katon
authors.affiliation: Department of Psychology, University of Washington, Seattle, Wash.
authors.forename: Evette
authors.initials: E
authors.lastname: Ludman
authors.affiliation: Department of Pediatrics, University of Washington School of Medicine, Seattle, Wash; Seattle Children's Research Institute Center for Child Health, Behavior, and Development, Seattle, Wash; Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, Wash.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: McCauley
authors.affiliation: Group Health Research Institute, Seattle, Wash.
authors.forename: Malia
authors.initials: M
authors.lastname: Oliver
authors.affiliation: Department of Psychology, University of Washington, Seattle, Wash.
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Lindenbaum
authors.affiliation: Department of Pediatrics, University of Washington School of Medicine, Seattle, Wash; Seattle Children's Research Institute Center for Child Health, Behavior, and Development, Seattle, Wash.
authors.forename: Laura P
authors.initials: LP
authors.lastname: Richardson
mesh_terms: D000293:Adolescent; D000553:Ambulatory Care / Q000191:economics / Q000706:statistics & numerical data; D003863:Depression / Q000453:epidemiology*; D004636:Emergency Service, Hospital / Q000191:economics / Q000706:statistics & numerical data; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data; D005102:Health Expenditures / Q000706:statistics & numerical data*; D006296:Health Services / Q000191:economics / Q000706:statistics & numerical data*; D006760:Hospitalization / Q000191:economics / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008403:Mass Screening
keywords: adolescent health; costs; depression; economic analysis; mental health; utilization