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Task Force recommends screening adolescents for clinical depression

The U.S. Preventive Services Task Force now recommends screening adolescents for clinical depression only when appropriate systems are in place to ensure accurate diagnosis, treatment, and followup care. This applies to all adolescents 12 to 18 years of age. In a separate recommendation, the Task Force found insufficient evidence to assess the balance of benefits and harms of screening children 7 to 11 years of age for clinical depression.

The Task Force reviewed new evidence on the benefits and harms of screening children and adolescents for clinical depression, the accuracy of screening tests administered in the primary care setting, and the benefits and risks of treating clinical depression using psychotherapy and/or medications in patients 7 to 18 years of age. Their conclusions are based on a report from a research team led by Selvi Williams, M.D., at the Kaiser Permanente Center for Health Research, which is part of AHRQ's Oregon Evidence-based Practice Center.

Clinical depression is an important cause of poor health and lower quality of life among children and adolescents. Depression can cause difficulties in school and disruptions of family and social relationships as well as diminished quality of life. Children and adolescents with depression are at an increased risk of suicide, which is the third leading cause of death among people aged 15 to 24 and the sixth leading cause of death among those aged 5 to 14. Adolescents suffering from clinical depression are also more likely to suffer from depression in early adulthood.

There is adequate evidence that treating adolescents with selective serotonin reuptake inhibitors (SSRIs), psychotherapy, or combined therapy (SSRIs and psychotherapy) results in decreased clinical depression symptoms. Treating clinically depressed youths with SSRIs is associated with an increased risk of suicidality (suicidal thoughts, preparation, and attempts of suicide) and, therefore, should only be considered if careful clinical supervision is possible.

See "Screening and treatment for major depressive disorder in children and adolescents: US Preventive Services Task Force Recommendation Statement," by Ned Calonge, M.D., M.P.H., Diana B. Petitti, M.D., M.P.H., Thomas G. DeWitt, M.D., and others in the April 2009 Pediatrics 123(4), pp. 1223-1228.

Editor's Note: The Task Force is the leading independent panel of experts in prevention and primary care. The Task Force, which is supported by the Agency for Healthcare Research and Quality, conducts rigorous, impartial assessments of the scientific evidence for the effectiveness of a broad range of clinical preventive services, including screening, counseling, and preventive medications. Its recommendations are considered the gold standard for clinical preventive services. The recommendations and materials for clinicians for these and previous Task Force recommendations are available on the AHRQ Web site at http://www.ahrq.gov/clinic/uspstf/uspschdepr.htm. Clinical information is also available from AHRQ's National Guideline Clearinghouse™ at http://www.guideline.gov.

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