Depression Screening May Inaccurately Diagnose Kids and Teens

Retail clinicians on the lookout for signs of depression in their younger patients should be aware that the screening questionnaires used to identify the condition could lead to a misdiagnosis in children and adolescents.

A recent study published in theCanadian Journal of Psychiatryset out to evaluate the accuracy of the screening tools currently used to diagnose depression. To do so, researchers from McGill University evaluated 17 studies in which the results of screening questionnaires were compared with results from diagnostic interviews that determined whether the children or adolescents were truly depressed.

After assessing the methodology and results of these 17 studies, the researchers found that many were too small to definitively establish the accuracy of depression screening tools. Additionally, they determined that most of the studies failed to meet expected standards.

However, the researchers also determined that there was inadequate evidence to recommend any particular cut-off score for a depression diagnosis for this population among any of the questionnaires used.

“There was not a single tool with even moderate evidence of sufficient accuracy to effectively identify depressed children and adolescents without also incorrectly picking up many non-depressed children and adolescents,” said lead author Michelle Roseman, PhD, in a press release.

Based on the observed shortcomings of the screening tools, the study authors expressed concern and suggested that their use could possibly cause healthy children and teenagers to be misdiagnosed with depression.

“Our study shows that if depression screening were carried out using existing screening tools, many nondepressed children and adolescents would be mistakenly identified as depressed,” stated senior author Brett Thombs, PhD, in a press release. “This could lead to the unnecessary prescription of potentially harmful psychiatric medications and negative messages about the mental health of some children who do not have mental health disorders.”

Additionally, Dr. Thombs noted that determining which diagnosed patients are truly depressed may require the use of an extensive number of resources.

“These resources would then not be available to provide treatment to large numbers of children and adolescents who are known to have severe mental health problems, but who do not receive adequate care,” he explained.

The researchers concluded that large, well-designed studies that present results across a range of cut-off scores are required to properly assess the accuracy of depression screening tools in children and teens.

In the meantime, clinicians should keep in mind that depression symptoms aren’t always one-size-fits-all—especially among children and adolescents. Therefore, it’s highly important for clinicians to review a patient’s medical records and treatment history and to collaborate with the primary care physician when determining the appropriateness of a depression treatment regimen for a given patient.