Screening for depression in children and adolescents in primary care or non-mental health settings: a systematic review update.

BACKGROUND: The transition from childhood to adolescence is associated with an increase in rates of some psychiatric disorders, including major depressive disorder, a debilitating mood disorder. The aim of this systematic review is to update the evidence on the benefits and harms of screening for depression in primary care and non-mental health clinic settings among children and adolescents. METHODS: This review is an update of a previous systematic review, for which the last search was conducted in 2017. We searched Ovid MEDLINE® ALL, Embase Classic+Embase, PsycINFO, Cochrane Central Register of Controlled Trials, and CINAHL on November 4, 2019, and updated on February 19, 2021. If no randomized controlled trials were found, we planned to conduct an additional search for non-randomized trials with a comparator group. For non-randomized trials, we applied a non-randomized controlled trial filter and searched the same databases except for Cochrane Central Register of Controlled Trials from January 2015 to February 2021. We also conducted a targeted search of the gray literature for unpublished documents. Title and abstract, and full-text screening were completed independently by pairs of reviewers. RESULTS: In this review update, we were unable to find any randomized controlled studies that satisfied our eligibility criteria and evaluated the potential benefits and harms of screening for depression in children and adolescents. Additionally, a search for non-randomized trials yielded no studies that met the inclusion criteria. CONCLUSIONS: The findings of this review indicate a lack of available evidence regarding the potential benefits and harms of screening for depression in children and adolescents. This absence of evidence emphasizes the necessity for well-conducted clinical trials to evaluate the effectiveness of depression screening among children and adolescents in primary care and non-mental health clinic settings. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42020150373 .

Clinician commentary on "Integrated care is associated with increased behavioral health access and utilization for youth in crisis" by Sean O'Dell.

Comments on the article "Integrated care is associated with increased behavioral health access and utilization for youth in crisis" by Sean O'Dell (see record 2022-06988-003). As a pediatrician with a practice focused exclusively on pediatric mental health, I am highly motivated to improve care by minimizing barriers to accessing care, and ensuring that the right care is delivered at the right time and in the right place. I am based in the outpatient clinic of a large mental health hospital (Waypoint Center for Mental Health Care) in rural central Ontario. As part of this program, I also have the opportunity to support integrated care clinics at four Family Health Teams (analogous to patient-centered medical homes), where I collaborate with child and youth therapists and primary care providers. In this setting, there is improved information sharing among the clinical team members, including shared documentation, which improves access and quality of care for pediatric patients and their families. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Screening for depression in children and adolescents: a protocol for a systematic review update.

BACKGROUND: Major depressive disorder is common, debilitating, and affects feelings, thoughts, mood, and behaviors. Childhood and adolescence are critical periods for the development of depression and adolescence is marked by an increased incidence of mental health disorders. This protocol outlines the planned scope and methods for a systematic review update that will evaluate the benefits and harms of screening for depression in children and adolescents. METHODS: This review will update a previously published systematic review by Roseman and colleagues. Eligible studies are randomized controlled trials (RCTs) assessing formal screening in primary care to identify children or adolescents not already self-reporting symptoms of, diagnosed with, or treated for depression. If no or only a single RCT is available, we will consider controlled studies without random assignment. Studies of participants with characteristics associated with an elevated risk of depression will be analyzed separately. Outcomes of interest are symptoms of depression, classification of major depressive disorder based on a validated diagnostic interview, suicidality, health-related quality of life, social function, impact on lifestyle behavior (e.g., substance use, school performance, lost time at work, or school), false-positive results, overdiagnosis, overtreatment, labeling, and other harms such as those arising from treatment. We will search MEDLINE, Embase, PsycINFO, CINAHL, the Cochrane Library, and grey literature sources. Two reviewers will independently screen the titles and abstracts using the liberal accelerated method. Full-text screening will be performed independently by two reviewers using pre-specified eligibility criteria. Data extraction and risk of bias assessments will be performed independently by two reviewers. Pre-planned analyses, including subgroup and sensitivity analyses, are detailed within this protocol. Two independent reviewers will assess and finalize through consensus the certainty of evidence using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach, and prepare GRADE evidence profiles and summary of findings tables for each outcome of interest. DISCUSSION: The systematic review will provide a current state of the evidence of benefits and harms of depression screening in children and adolescents. These findings will be used by the Canadian Task Force on Preventive Health Care to inform the development of recommendations on depression screening. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42020150373.

Audit of pulse oximetry screening for critical congenital heart disease (CCHD) in newborns.

OBJECTIVES: To assess the efficacy of a new screening protocol for critical congenital heart disease (CCHD). BACKGROUND: In March 2014, the Ontario Provincial Council for Maternal Child Health (PCMCH) recommended screening for CCHD, utilizing pulse oximetry to measure oxygen saturation as part of the newborn examination. However, this is yet to be implemented in all hospitals. METHOD: An audit of consecutive healthy normal newborn patients in a secondary level centre in Ontario with early adoption of the screening recommendation over a 1-year period was undertaken. RESULTS: The median age of screening was 25 hours (6 to 80 hours). Compliance was 88% (95% if one excludes deliveries by a midwife as they did not agree to comply). Four patients screened positive and were seen by a paediatrician in consultation but did not have CCHD (specificity 99.4%). CONCLUSIONS: The current study shows that screening was successfully implemented in a Canadian hospital, with high specificity (99.4%) and good compliance (88%). Reasons for non-acceptance of screening by midwives need to be addressed.

Transient erythroblastopenia of childhood in siblings: case report and review of the literature.

Transient erythroblastopenia of childhood is characterized by anemia due to decreased production of red blood cell precursors. It is almost always self-resolving and requires clinical intervention only in severe cases. This article describes 2 cases in half-siblings diagnosed approximately 10 years apart. A review of the literature identifies 11 other sibling pairs. Our case suggests an autosomal dominant pattern of inheritance. To date, the gene involved in the development of transient erythroblastopenia of childhood has not been identified.

Gardner-Diamond syndrome: Difficulties in the management of patients with unexplained medical symptoms.

The case of an adolescent girl who presented with unexplained bruising is reported. Subsequent investigations failed to elucidate an organic etiology. The diagnosis of Gardner-Diamond syndrome - a syndrome of predictable bruising preceded by pain and warmth at the bruise site, often associated with physical or psychosocial stress - was made. In the present report, the authors use their experience with this rare syndrome to highlight some important ethical and practical considerations with regard to investigation, treatment and communication in illnesses with unexplained medical symptoms.