Abstract
BackgroundDepression is an important cause of disability among children and adolescents. Depression screening is one possible method for managing depression, and screening programs have been initiated in some school and medical settings. However, in 2005, the Canadian Task Force on Preventive Health Care and the United Kingdom National Institute of Clinical Excellence did not recommend depression screening among children and adolescents. By contrast, in 2009, the United States Preventive Services Task Force recommended that all adolescents, but not younger children, be screened for depression in medical settings with integrated depression management services, although no trials of screening were identified. The objectives of this systematic review are to evaluate in children and adolescents the accuracy of depression screening tools; depression treatment efficacy; whether depression screening improves depression outcomes; and potential harms related to depression interventions and screening.Methods/designData sources will include the bibliographic databases MEDLINE, Cochrane CENTRAL, PsycINFO, EMBASE, LILACS and Web of Science, supplemented by reference harvesting of eligible articles, relevant systematic reviews, relevant guidelines and recommendations, and selected journals, and by searches for unpublished studies. Eligible studies will report data for children and adolescents aged 6 to 18 years. Eligible diagnostic accuracy studies must compare a depression screening tool to a validated diagnostic interview for major depressive disorder and report diagnostic accuracy data. Eligible treatment studies must be randomized controlled trials of pharmacological, psychotherapeutic, or other depression treatments commonly available for children and adolescents in pediatric, primary-care, and family medicine settings. Eligible screening studies must be randomized controlled trials that compare depression outcomes between children or adolescents who underwent depression screening versus those who did not. Studies of harms will include randomized controlled trials and observational studies that evaluate harms from depression screening or treatment. Two investigators will independently review titles and abstracts, followed by full article review. Disagreements will be resolved by consensus. Two investigators will independently extract the data, with discrepancies resolved via consensus.DiscussionThe proposed systematic review will determine whether there is sufficient evidence of benefits in excess of harms and costs to support screening for depression in childhood and adolescence.
Highlights
Depression is an important cause of disability among children and adolescents
The proposed systematic review will determine whether there is sufficient evidence of benefits in excess of harms and costs to support screening for depression in childhood and adolescence
Trials of actual screening programs, in which health outcomes are evaluated for screened versus unscreened children and adolescents are, if they exist, the final standard by which the value of screening can be tested in terms of its ability to improve depression outcomes and produce benefits to children and adolescents that exceed potential harms from screening
Summary
Depression in children and adolescents is a disabling condition that is associated with long-term mental and physical health problems [1]. Key Question #2 (effects of treatment): Studies on treatment will include RCTs with placebo or usual care controls that evaluated pharmacological, psychotherapeutic, or other interventions that would typically be available to children or adolescents in general pediatric settings or primary-care and family medicine settings as treatment for depression as diagnosed with a validated psychiatric interview and DSM criteria for MDD or ICD criteria for a depressive episode. For Key Questions #2 (effects of treatment) and #3 (effects of screening), we will use the Cochrane Risk of Bias tool [39], which includes assessments of six possible sources of bias related to randomization sequence generation; allocation concealment; blinding of participants, personnel, and outcome assessors; incomplete outcome data; selective outcome data; and other sources of bias In addition to these domains, based on recent recommendations regarding potential bias due to financial conflicts of interest [40,41], we will code two further domains, for pharmaceutical industry funding, and author-industry financial ties or employment by industry. If, following the full literature review, we find that meta-analytic data pooling is feasible, we will use appropriate models that have been used previously in meta-analyses of diagnostic accuracy [43], screening effectiveness [44], and treatment outcomes from depression care interventions [45,46]
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