Abstract
Unique trajectories of adolescent depression symptoms have been identified, yet less is known about whether such patterns translate to real-world clinical settings. Because annual adolescent depression screening is becoming more prevalent in primary care, we examined whether longitudinal patterns of depression symptoms documented in the developmental psychopathology literature can also be detected via routine screening in primary care and explored how membership in the identified trajectories varied based on concurrent suicide risk and sociodemographic factors. A total of 1,359 adolescents aged 12–16 years old at the first timepoint were included in the current analyses. These adolescents completed three depression screeners during their well-visits in a large pediatric primary care network between November 15, 2017 and February 1, 2020. Retrospective electronic health record data were extracted, including sociodemographic variables and depression screening results. Dynamic functional time series clustering results indicated the optimal number of clusters was five. The five depression symptom trajectories were: (1) A-Shaped (i.e., relatively low depression symptoms at Time 1, a substantial increase in symptoms at Time 2, and a return to low symptoms at Time 3), (2) Increasing, (3) Low-Stable, (4) High-Decreasing, and (5) Low-Decreasing. Cluster differences in suicide risk largely mapped onto depression symptom levels at each assessment. We found cluster differences based on practice location, insurance type, and adolescent race. The symptom trajectories observed in this study resemble those found in the developmental psychopathology literature, though some key differences were noted. Findings can inform future research and symptom monitoring in primary care.
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Because these data were obtained from the electronic health record with a waiver of consent, they are not publicly available.
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Acknowledgements
We want to thank the network of primary care clinicians, their patients and families for their contributions to this project. Clinical research was facilitated through the Pediatric Research Consortium (PeRC) at the Children’s Hospital of Philadelphia.
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This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. The implementation of the larger electronic screening program described in this manuscript was funded under grant CFDA 93.767 from the U.S. Department of Health and Human Services, Centers for Medicare & Medicaid Services. However, the content of this manuscript does not necessarily represent the policy of the U.S. Department of Health and Human Services, and you should not assume endorsement by the Federal Government.
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All authors helped conceptualize and design the manuscript and reviewed and revised the manuscript. Dr. Davis drafted the initial manuscript, with assistance from Dr. Jones. Dr. Gallop conducted the analyses and Drs. Gallop, Jones and Davis interpreted the analyses. All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.
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Davis, M., Jones, J.D., Gallop, R. et al. Adolescent Depression Symptom Trajectories Detected Via Universal Screening in Pediatric Primary Care. Res Child Adolesc Psychopathol 52, 183–194 (2024). https://doi.org/10.1007/s10802-023-01116-2
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DOI: https://doi.org/10.1007/s10802-023-01116-2