Draft Research Plan
Depression in Children and Adolescents: Screening
May 15, 2013
Recommendations made by the USPSTF are independent of the U.S. government. They should not be construed as an official position of the Agency for Healthcare Research and Quality or the U.S. Department of Health and Human Services.
1a. Does screening for depression in children and adolescents in the primary care setting lead to improved health and other related outcomes?
1b. Does screening for depression in children and adolescents lead to improved health and other related outcomes for subgroups defined by age, sex, or race/ethnicity?
2a. Are screening instruments for depression in children and adolescents accurate in identifying depression in primary care or comparable (e.g., school-based clinic) settings?
2b. What is the proportion of children and adolescents who are accurately identified with depression by screening in subgroups defined by age, sex, or race/ethnicity?
3a. Does screening increase the proportion of patients identified with or treated for depression?
3b. Does screening increase the proportion of patients identified with or treated for depression in subgroups defined by age, sex, or race/ethnicity?
4a. What are the harms of screening for depression in children and adolescents?
4b. What are the harms of screening for depression in subgroups defined by age, sex, or race/ethnicity?
5a. Does treatment of depression in screen-detected children and adolescents identified in primary care or comparable settings improve health and other related outcomes?
5b. What are the benefits of treatment of depression in subgroups defined by age, sex, or race/ethnicity?
6a. What are the harms of depression treatment for children and adolescents?
6b. What are the harms of depression treatment for subgroups defined by age, sex, or race/ethnicity?
These key questions (KQs) reflect important changes since the 2009 systematic review. All KQs now explicitly incorporate a subquestion on subgroups. In addition to the subgroup of primary interest in the 2009 review (age), the KQs also ask about sex and race/ethnicity.
Contextual questions are not systematically reviewed and are not shown in the Analytic Framework.
Valid and reliable risk stratification tools may enhance the U.S. Preventive Services Task Force's (USPSTF's) ability to provide targeted recommendations for risk groups. Contextual information on uptake of existing recommendations may help tailor updated recommendations. The issues of risk factors and uptake of USPSTF recommendations will be addressed through the following contextual questions.
- What proportion of primary care providers assess, treat, and refer child and adolescent patients with depression (i.e., major depressive disorder [MDD], dysthymia, and minor depression)? What proportion of primary care providers have access to collaborative systems of care for these patients?
- What are the most common types of treatments for MDD in children and adolescents that can be initiated in or referred from primary care, school clinics, or comparable settings? Is there evidence of valid and reliable risk stratification tools to identify children and adolescents at highest risk for depression?
- Are children and adolescents with depression and comorbid mental health (e.g., attention deficit hyperactivity disorder, anxiety disorders) or chronic physical health conditions (e.g., diabetes, asthma) in primary care, school clinics, or comparable settings more likely to be screened, treated, or referred for treatment than children or adolescents with depression only? Do these patients receive different treatments from children and adolescents without comorbidities?
- Is there evidence of other types of effective treatments for depression in children and adolescents, such as other types of pharmacotherapy (e.g., serotonin–norepinephrine reuptake inhibitors, norepinephrine–dopamine reuptake inhibitors) or complementary and alternative medicine therapy?
The Proposed Research Approach identifies the study characteristics and criteria that the Evidence-based Practice Center will use to search for publications and to determine whether identified studies should be included or excluded from the Evidence Report. Criteria are overarching as well as specific to each of the KQs.
Inclusion | Exclusion | |
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Populations | Children and adolescents ages 7–18 years screened or treated for depression |
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Interventions: Screening |
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Interventions: Treatment |
Pharmacological interventions:
Psychotherapy interventions:
System-level interventions:
Combined interventions:
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Pharmacological interventions:
Other therapy:
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Comparisons |
KQs 1, 3, 4:
KQ 2:
KQ 5:
KQ 6:
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KQs 1, 3–6:
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Outcomes |
KQs 1, 5:
Primary outcomes of interest:
Additional outcomes of interest:
KQ 2:
KQ 3:
KQ 4:
KQ 6:
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KQs 1, 3–6:
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Timing |
KQs 1, 3–6:
KQ 2:
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KQs 1, 3–6:
KQ 2:
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Settings |
KQs 1–4:
KQs 5, 6:
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KQs 1–4:
KQs 5, 6:
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Study Designs |
KQs 1, 3–6:
KQ 2:
KQs 4, 6:
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KQs 1, 3–6:
KQs 1, 3:
KQ 2:
KQs 4, 6:
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Language | English | Non-English |