Depression symptoms are common for youth with diabetes and may negatively affect quality of life and health outcomes. In our large, urban, pediatric diabetes clinic, depression screening with a condensed, verbally-administered measure, the Patient Health Questionnaire-2 (PHQ-2), had a positivity rate of only 2%, which is far below anticipated rates. We developed a quality improvement project to increase the sensitivity of depression screening for youth with diabetes. The primary test of change was electronically administering the Patient Health Questionnaire for Adolescents (PHQ-A), a 13-question survey validated for use in pediatrics. Youths ≥ 12 years of age were asked to privately complete the PHQ-A on a laptop at a diabetes visit annually. Responses populated within the electronic health record, and medical providers were trained to respond to positive screens with the support of a social worker or psychologist. A run chart was used to assess screen-positivity rate over time; ≥6 points above the baseline was considered a significant change. During the study period (August 2018—February 2020), 740 PHQ-A screens were completed by 618 patients. The majority of patients (n = 489; 79%) had type 1 diabetes, 50% were female, and the median age (IQR) at screening was 16.2 (14.0-18.0) years. On average, 38.9 screens/month were completed (range: 16-70), and 6.8 screens/month were positive (range: 0-16). Of all completed screens, 129 (17.4%) were positive. The positivity rate was greater than baseline for all 7 quarters evaluated after implementation of PHQ-A. Of the positive screens, 55 (43%) were positive due only to SI or SA history. Using a standardized and easily administered approach, the detection of depression symptoms increased to a range comparable to previous reports. The number of completed screens per month was manageable, allowing us to promptly address depression symptoms within our interdisciplinary clinic workflow.
J. Gettings: None. S. M. Willi: Advisory Panel; Self; Boehringer Ingelheim International GmbH, Medtronic, Other Relationship; Self; National Institute of Diabetes and Digestive and Kidney Diseases. O. Patil: None. M. Vajravelu: None. C. P. Hawkes: None. A. Tuttle: None. M. Buzby: None. S. Crean: None. M. B. Dever: None. L. Mulligan: None.