title: Screening for and Diagnosis of Depression Among Adolescents in a Large Health Maintenance Organization.
abstract: The aim of this analysis was to determine changes in patterns of depression screening and diagnosis over three years in primary and specialty mental health care in a large health maintenance organization (HMO) as part of a project to develop quality measures for adolescent depression treatment.
  
  
  
  Two series of aggregate data (2010-2012) were gathered from the electronic health records of the HMO for 44,342 unique adolescents (ages 12 to 21) who had visits in primary and mental health care. Chi square tests assessed the significance of changes in frequency and departmental location of Patient Health Questionnaire-9 (PHQ-9) administration, incidence of depression symptoms, and depression diagnoses.
  
  
  
  There was a significant increase in PHQ-9 use, predominantly in primary care, consistent with internally generated organizational recommendations to increase screening with the PHQ-9. The increase in PHQ-9 use led to an increase in depression diagnoses in primary care and a shift in the location of some diagnoses from specialty mental health care to primary care. The increase in PHQ-9 use was also linked to a decrease in the proportion of positive PHQ-9 results that led to formal depression diagnoses.
  
  
  
  The rate of depression screening in primary care increased over the study period. This increase corresponded to an increase in the number of depression diagnoses made in primary care and a shift in the location in which depression diagnoses were made, from the mental health department to primary care. The frequency of positive PHQ-9 administrations not associated with depression diagnoses also increased.
authors.affiliation: Dr. Lewandowski, Dr. O'Connor, Dr. Hoagwood, and Dr. Horwitz are with the Department of Child and Adolescent Psychiatry, New York University, New York (e-mail: eric.lewandowski@nyumc.org ). Dr. Bertagnolli and Ms. deSa are with the Care Management Institute, Kaiser Permanente, Oakland, California. Dr. Beck, Mr. Wain, Ms. Boggs, and Ms. Brace are with the Institute for Health Research, Dr. Jelinek-Berents is with the Department of Pediatrics, and Dr. Newton is with the Care Management Institute and the Department of Child and Adolescent Psychiatry, all at Kaiser Permanente of Colorado, Denver. Dr. Tinoco and Dr. Hudson Scholle are with the National Committee for Quality Assurance, Washington, D.C. Dr. Gardner is with the Research Institute of Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada, and with the Department of Pediatrics, Ohio State University, Columbus.
authors.forename: R Eric
authors.initials: RE
authors.lastname: Lewandowski
authors.affiliation: Dr. Lewandowski, Dr. O'Connor, Dr. Hoagwood, and Dr. Horwitz are with the Department of Child and Adolescent Psychiatry, New York University, New York (e-mail: eric.lewandowski@nyumc.org ). Dr. Bertagnolli and Ms. deSa are with the Care Management Institute, Kaiser Permanente, Oakland, California. Dr. Beck, Mr. Wain, Ms. Boggs, and Ms. Brace are with the Institute for Health Research, Dr. Jelinek-Berents is with the Department of Pediatrics, and Dr. Newton is with the Care Management Institute and the Department of Child and Adolescent Psychiatry, all at Kaiser Permanente of Colorado, Denver. Dr. Tinoco and Dr. Hudson Scholle are with the National Committee for Quality Assurance, Washington, D.C. Dr. Gardner is with the Research Institute of Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada, and with the Department of Pediatrics, Ohio State University, Columbus.
authors.forename: Briannon
authors.initials: B
authors.lastname: O'Connor
authors.affiliation: Dr. Lewandowski, Dr. O'Connor, Dr. Hoagwood, and Dr. Horwitz are with the Department of Child and Adolescent Psychiatry, New York University, New York (e-mail: eric.lewandowski@nyumc.org ). Dr. Bertagnolli and Ms. deSa are with the Care Management Institute, Kaiser Permanente, Oakland, California. Dr. Beck, Mr. Wain, Ms. Boggs, and Ms. Brace are with the Institute for Health Research, Dr. Jelinek-Berents is with the Department of Pediatrics, and Dr. Newton is with the Care Management Institute and the Department of Child and Adolescent Psychiatry, all at Kaiser Permanente of Colorado, Denver. Dr. Tinoco and Dr. Hudson Scholle are with the National Committee for Quality Assurance, Washington, D.C. Dr. Gardner is with the Research Institute of Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada, and with the Department of Pediatrics, Ohio State University, Columbus.
authors.forename: Andrew
authors.initials: A
authors.lastname: Bertagnolli
authors.affiliation: Dr. Lewandowski, Dr. O'Connor, Dr. Hoagwood, and Dr. Horwitz are with the Department of Child and Adolescent Psychiatry, New York University, New York (e-mail: eric.lewandowski@nyumc.org ). Dr. Bertagnolli and Ms. deSa are with the Care Management Institute, Kaiser Permanente, Oakland, California. Dr. Beck, Mr. Wain, Ms. Boggs, and Ms. Brace are with the Institute for Health Research, Dr. Jelinek-Berents is with the Department of Pediatrics, and Dr. Newton is with the Care Management Institute and the Department of Child and Adolescent Psychiatry, all at Kaiser Permanente of Colorado, Denver. Dr. Tinoco and Dr. Hudson Scholle are with the National Committee for Quality Assurance, Washington, D.C. Dr. Gardner is with the Research Institute of Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada, and with the Department of Pediatrics, Ohio State University, Columbus.
authors.forename: Arne
authors.initials: A
authors.lastname: Beck
authors.affiliation: Dr. Lewandowski, Dr. O'Connor, Dr. Hoagwood, and Dr. Horwitz are with the Department of Child and Adolescent Psychiatry, New York University, New York (e-mail: eric.lewandowski@nyumc.org ). Dr. Bertagnolli and Ms. deSa are with the Care Management Institute, Kaiser Permanente, Oakland, California. Dr. Beck, Mr. Wain, Ms. Boggs, and Ms. Brace are with the Institute for Health Research, Dr. Jelinek-Berents is with the Department of Pediatrics, and Dr. Newton is with the Care Management Institute and the Department of Child and Adolescent Psychiatry, all at Kaiser Permanente of Colorado, Denver. Dr. Tinoco and Dr. Hudson Scholle are with the National Committee for Quality Assurance, Washington, D.C. Dr. Gardner is with the Research Institute of Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada, and with the Department of Pediatrics, Ohio State University, Columbus.
authors.forename: Aldo
authors.initials: A
authors.lastname: Tinoco
authors.affiliation: Dr. Lewandowski, Dr. O'Connor, Dr. Hoagwood, and Dr. Horwitz are with the Department of Child and Adolescent Psychiatry, New York University, New York (e-mail: eric.lewandowski@nyumc.org ). Dr. Bertagnolli and Ms. deSa are with the Care Management Institute, Kaiser Permanente, Oakland, California. Dr. Beck, Mr. Wain, Ms. Boggs, and Ms. Brace are with the Institute for Health Research, Dr. Jelinek-Berents is with the Department of Pediatrics, and Dr. Newton is with the Care Management Institute and the Department of Child and Adolescent Psychiatry, all at Kaiser Permanente of Colorado, Denver. Dr. Tinoco and Dr. Hudson Scholle are with the National Committee for Quality Assurance, Washington, D.C. Dr. Gardner is with the Research Institute of Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada, and with the Department of Pediatrics, Ohio State University, Columbus.
authors.forename: William P
authors.initials: WP
authors.lastname: Gardner
authors.affiliation: Dr. Lewandowski, Dr. O'Connor, Dr. Hoagwood, and Dr. Horwitz are with the Department of Child and Adolescent Psychiatry, New York University, New York (e-mail: eric.lewandowski@nyumc.org ). Dr. Bertagnolli and Ms. deSa are with the Care Management Institute, Kaiser Permanente, Oakland, California. Dr. Beck, Mr. Wain, Ms. Boggs, and Ms. Brace are with the Institute for Health Research, Dr. Jelinek-Berents is with the Department of Pediatrics, and Dr. Newton is with the Care Management Institute and the Department of Child and Adolescent Psychiatry, all at Kaiser Permanente of Colorado, Denver. Dr. Tinoco and Dr. Hudson Scholle are with the National Committee for Quality Assurance, Washington, D.C. Dr. Gardner is with the Research Institute of Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada, and with the Department of Pediatrics, Ohio State University, Columbus.
authors.forename: Christine X
authors.initials: CX
authors.lastname: Jelinek-Berents
authors.affiliation: Dr. Lewandowski, Dr. O'Connor, Dr. Hoagwood, and Dr. Horwitz are with the Department of Child and Adolescent Psychiatry, New York University, New York (e-mail: eric.lewandowski@nyumc.org ). Dr. Bertagnolli and Ms. deSa are with the Care Management Institute, Kaiser Permanente, Oakland, California. Dr. Beck, Mr. Wain, Ms. Boggs, and Ms. Brace are with the Institute for Health Research, Dr. Jelinek-Berents is with the Department of Pediatrics, and Dr. Newton is with the Care Management Institute and the Department of Child and Adolescent Psychiatry, all at Kaiser Permanente of Colorado, Denver. Dr. Tinoco and Dr. Hudson Scholle are with the National Committee for Quality Assurance, Washington, D.C. Dr. Gardner is with the Research Institute of Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada, and with the Department of Pediatrics, Ohio State University, Columbus.
authors.forename: Douglas A
authors.initials: DA
authors.lastname: Newton
authors.affiliation: Dr. Lewandowski, Dr. O'Connor, Dr. Hoagwood, and Dr. Horwitz are with the Department of Child and Adolescent Psychiatry, New York University, New York (e-mail: eric.lewandowski@nyumc.org ). Dr. Bertagnolli and Ms. deSa are with the Care Management Institute, Kaiser Permanente, Oakland, California. Dr. Beck, Mr. Wain, Ms. Boggs, and Ms. Brace are with the Institute for Health Research, Dr. Jelinek-Berents is with the Department of Pediatrics, and Dr. Newton is with the Care Management Institute and the Department of Child and Adolescent Psychiatry, all at Kaiser Permanente of Colorado, Denver. Dr. Tinoco and Dr. Hudson Scholle are with the National Committee for Quality Assurance, Washington, D.C. Dr. Gardner is with the Research Institute of Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada, and with the Department of Pediatrics, Ohio State University, Columbus.
authors.forename: Kris F
authors.initials: KF
authors.lastname: Wain
authors.affiliation: Dr. Lewandowski, Dr. O'Connor, Dr. Hoagwood, and Dr. Horwitz are with the Department of Child and Adolescent Psychiatry, New York University, New York (e-mail: eric.lewandowski@nyumc.org ). Dr. Bertagnolli and Ms. deSa are with the Care Management Institute, Kaiser Permanente, Oakland, California. Dr. Beck, Mr. Wain, Ms. Boggs, and Ms. Brace are with the Institute for Health Research, Dr. Jelinek-Berents is with the Department of Pediatrics, and Dr. Newton is with the Care Management Institute and the Department of Child and Adolescent Psychiatry, all at Kaiser Permanente of Colorado, Denver. Dr. Tinoco and Dr. Hudson Scholle are with the National Committee for Quality Assurance, Washington, D.C. Dr. Gardner is with the Research Institute of Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada, and with the Department of Pediatrics, Ohio State University, Columbus.
authors.forename: Jennifer M
authors.initials: JM
authors.lastname: Boggs
authors.affiliation: Dr. Lewandowski, Dr. O'Connor, Dr. Hoagwood, and Dr. Horwitz are with the Department of Child and Adolescent Psychiatry, New York University, New York (e-mail: eric.lewandowski@nyumc.org ). Dr. Bertagnolli and Ms. deSa are with the Care Management Institute, Kaiser Permanente, Oakland, California. Dr. Beck, Mr. Wain, Ms. Boggs, and Ms. Brace are with the Institute for Health Research, Dr. Jelinek-Berents is with the Department of Pediatrics, and Dr. Newton is with the Care Management Institute and the Department of Child and Adolescent Psychiatry, all at Kaiser Permanente of Colorado, Denver. Dr. Tinoco and Dr. Hudson Scholle are with the National Committee for Quality Assurance, Washington, D.C. Dr. Gardner is with the Research Institute of Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada, and with the Department of Pediatrics, Ohio State University, Columbus.
authors.forename: Nancy E
authors.initials: NE
authors.lastname: Brace
authors.affiliation: Dr. Lewandowski, Dr. O'Connor, Dr. Hoagwood, and Dr. Horwitz are with the Department of Child and Adolescent Psychiatry, New York University, New York (e-mail: eric.lewandowski@nyumc.org ). Dr. Bertagnolli and Ms. deSa are with the Care Management Institute, Kaiser Permanente, Oakland, California. Dr. Beck, Mr. Wain, Ms. Boggs, and Ms. Brace are with the Institute for Health Research, Dr. Jelinek-Berents is with the Department of Pediatrics, and Dr. Newton is with the Care Management Institute and the Department of Child and Adolescent Psychiatry, all at Kaiser Permanente of Colorado, Denver. Dr. Tinoco and Dr. Hudson Scholle are with the National Committee for Quality Assurance, Washington, D.C. Dr. Gardner is with the Research Institute of Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada, and with the Department of Pediatrics, Ohio State University, Columbus.
authors.forename: Patricia
authors.initials: P
authors.lastname: deSa
authors.affiliation: Dr. Lewandowski, Dr. O'Connor, Dr. Hoagwood, and Dr. Horwitz are with the Department of Child and Adolescent Psychiatry, New York University, New York (e-mail: eric.lewandowski@nyumc.org ). Dr. Bertagnolli and Ms. deSa are with the Care Management Institute, Kaiser Permanente, Oakland, California. Dr. Beck, Mr. Wain, Ms. Boggs, and Ms. Brace are with the Institute for Health Research, Dr. Jelinek-Berents is with the Department of Pediatrics, and Dr. Newton is with the Care Management Institute and the Department of Child and Adolescent Psychiatry, all at Kaiser Permanente of Colorado, Denver. Dr. Tinoco and Dr. Hudson Scholle are with the National Committee for Quality Assurance, Washington, D.C. Dr. Gardner is with the Research Institute of Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada, and with the Department of Pediatrics, Ohio State University, Columbus.
authors.forename: Sarah Hudson
authors.initials: SH
authors.lastname: Scholle
authors.affiliation: Dr. Lewandowski, Dr. O'Connor, Dr. Hoagwood, and Dr. Horwitz are with the Department of Child and Adolescent Psychiatry, New York University, New York (e-mail: eric.lewandowski@nyumc.org ). Dr. Bertagnolli and Ms. deSa are with the Care Management Institute, Kaiser Permanente, Oakland, California. Dr. Beck, Mr. Wain, Ms. Boggs, and Ms. Brace are with the Institute for Health Research, Dr. Jelinek-Berents is with the Department of Pediatrics, and Dr. Newton is with the Care Management Institute and the Department of Child and Adolescent Psychiatry, all at Kaiser Permanente of Colorado, Denver. Dr. Tinoco and Dr. Hudson Scholle are with the National Committee for Quality Assurance, Washington, D.C. Dr. Gardner is with the Research Institute of Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada, and with the Department of Pediatrics, Ohio State University, Columbus.
authors.forename: Kimberly
authors.initials: K
authors.lastname: Hoagwood
authors.affiliation: Dr. Lewandowski, Dr. O'Connor, Dr. Hoagwood, and Dr. Horwitz are with the Department of Child and Adolescent Psychiatry, New York University, New York (e-mail: eric.lewandowski@nyumc.org ). Dr. Bertagnolli and Ms. deSa are with the Care Management Institute, Kaiser Permanente, Oakland, California. Dr. Beck, Mr. Wain, Ms. Boggs, and Ms. Brace are with the Institute for Health Research, Dr. Jelinek-Berents is with the Department of Pediatrics, and Dr. Newton is with the Care Management Institute and the Department of Child and Adolescent Psychiatry, all at Kaiser Permanente of Colorado, Denver. Dr. Tinoco and Dr. Hudson Scholle are with the National Committee for Quality Assurance, Washington, D.C. Dr. Gardner is with the Research Institute of Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada, and with the Department of Pediatrics, Ohio State University, Columbus.
authors.forename: Sarah McCue
authors.initials: SM
authors.lastname: Horwitz
mesh_terms: D000293:Adolescent; D002648:Child; D003863:Depression / Q000175:diagnosis* / Q000453:epidemiology*; D057286:Electronic Health Records; D005260:Female; D006279:Health Maintenance Organizations / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000379:methods; D011569:Psychiatric Status Rating Scales; D057566:Self Report; D014481:United States; D055815:Young Adult