Predictors of Mental Health Status in Adolescents
Predictors of Mental Health Status in Adolescents
This cross-sectional study describes the reported concerns, health risks, behaviors, and assets of a population of adolescents attending preventive well-child visits. Data are from the Dartmouth Healthy Teens Screener, a personal digital assistant (PDA)–based questionnaire that quickly and effectively screens adolescents for health risks in primary care practices while providing clinicians with a road map for tailored counseling based on the adolescent's readiness to change key health risk behaviors.
The PDA health screener was administered as part of clinical care to adolescents aged 11 to 21 years old (N = 2535) who attended preventive well-child visits in 13 pediatric and family medicine primary care practices in Vermont and New Hampshire over 18 months (2008 to 2009). These practices are located in small communities with populations varying from 1000 to 50,000 people, all of which are part of the Clinicians Enhancing Child Health primary care practice-based research network. (All practices continue to use this screener 3 years after the data deadline for this study.) Data were utilized by the provider during the visit and de-identified data were transmitted regularly to an central electronic database. Full descriptions of the methodology used for the development and confirmation of the PDA-based screener as an effective tool already have been published.
The Healthy Teens Screener is an electronic questionnaire that employs a branching algorithm, allowing adolescents to answer between 60 and 90 health behavior questions before a formal preventive well-child visit. The screener comprehensively covers health, mental health, and social issues relevant to adolescents. The adolescents can indicate from a list of emotional and physical issues which ones are of concern to them that they would like to discuss further with a clinician.
Since the last report of the Healthy Teens Screener, the screener has been enhanced with the addition of validated, 2-question depression and anxiety screens as well as a strength-based section (the latter after consultation with Paula Duncan of the University of Vermont). The inclusion of strength-based questions allows determination of the role of protective factors in an adolescent's risk for depression and anxiety.
Using the screener, for a patient to screen positive, that is, to be "at risk" for depression or anxiety, they had to have a score of ≥3 of 6 on the brief depression and anxiety measures: the 2-question Patient Health Questionnaire (PHQ-2) and Generalized Anxiety Disorder scale (GAD-2), respectively. Each of the questionnaires has 2 questions scored from 0 to 3 (0 = "none of the time," 1 = "some of the time," 2 = "half of the time," and 3 = "all the time"). The 2 questions are each summed on a scale of 0 to 6, with totals ≥3 scored as positive. These methods of screening for depression and anxiety with the above cut points have been validated previously; the PHQ-2 has a sensitivity of 79% and a specificity of 86% for any depressive disorder, and the GAD-2 has a sensitivity of 86% and a specificity of 83% for generalized anxiety disorder. The PHQ-2 has been validated in adolescent populations as well.
The 4 strength-based questions were summed for this analysis, creating a single "Asset" category to show how protective factors were related to depression and anxiety symptoms in adolescents. Questions related to substance use (alcohol, tobacco, marijuana, and illicit drug use) were scored together as one risk factor because of the frequent overlap in these behaviors.
The Healthy Teens Screener has two formats: one for younger teens (11 to 14 years old) and one for older adolescents (15 to 21 years old). For the purpose of this study, only questions represented in both iterations were used, allowing for the development of a congruent dataset among the entire study population. The dataset use for the current analysis was limited to 11 to 18 year olds (N = 2184) because of the small numbers in older age groups. Dartmouth Medical School's institutional review board, the Committee for the Protection of Human Subjects at Dartmouth College, approved the study protocol.
For this report, items that potentially are associated with increased likelihood of a positive screen for depression or anxiety were determined from literature review. The next step was to determine the items' association with screening positive for depression or anxiety at the bivariate level. In addition to the strength-based questions, 2 questions about familial and peer psychosocial support were asked. The assets and psychosocial support questions together constitute the protective factors, shielding the adolescents from depression and anxiety.
Our data analysis explored the role that the protective and social risk factors played in determining who screens positive for depression and anxiety. First, bivariate t tests and χ tests were used to establish the set of questions that were associated with positive screens of depression and anxiety. Unadjusted and adjusted logistic regression analyses were then conducted using all the symptoms identified by the bivariate methods, establishing which protective or social risk factors were individual, significant predictors for either screening positive for depression or screening positive for anxiety. All statistical tests were performed using SPSS 18.0 (IBM, Chicago, IL).
Patients and Methods
Study Design and Population
This cross-sectional study describes the reported concerns, health risks, behaviors, and assets of a population of adolescents attending preventive well-child visits. Data are from the Dartmouth Healthy Teens Screener, a personal digital assistant (PDA)–based questionnaire that quickly and effectively screens adolescents for health risks in primary care practices while providing clinicians with a road map for tailored counseling based on the adolescent's readiness to change key health risk behaviors.
The PDA health screener was administered as part of clinical care to adolescents aged 11 to 21 years old (N = 2535) who attended preventive well-child visits in 13 pediatric and family medicine primary care practices in Vermont and New Hampshire over 18 months (2008 to 2009). These practices are located in small communities with populations varying from 1000 to 50,000 people, all of which are part of the Clinicians Enhancing Child Health primary care practice-based research network. (All practices continue to use this screener 3 years after the data deadline for this study.) Data were utilized by the provider during the visit and de-identified data were transmitted regularly to an central electronic database. Full descriptions of the methodology used for the development and confirmation of the PDA-based screener as an effective tool already have been published.
Measures: The Healthy Teens Screener
The Healthy Teens Screener is an electronic questionnaire that employs a branching algorithm, allowing adolescents to answer between 60 and 90 health behavior questions before a formal preventive well-child visit. The screener comprehensively covers health, mental health, and social issues relevant to adolescents. The adolescents can indicate from a list of emotional and physical issues which ones are of concern to them that they would like to discuss further with a clinician.
Since the last report of the Healthy Teens Screener, the screener has been enhanced with the addition of validated, 2-question depression and anxiety screens as well as a strength-based section (the latter after consultation with Paula Duncan of the University of Vermont). The inclusion of strength-based questions allows determination of the role of protective factors in an adolescent's risk for depression and anxiety.
Using the screener, for a patient to screen positive, that is, to be "at risk" for depression or anxiety, they had to have a score of ≥3 of 6 on the brief depression and anxiety measures: the 2-question Patient Health Questionnaire (PHQ-2) and Generalized Anxiety Disorder scale (GAD-2), respectively. Each of the questionnaires has 2 questions scored from 0 to 3 (0 = "none of the time," 1 = "some of the time," 2 = "half of the time," and 3 = "all the time"). The 2 questions are each summed on a scale of 0 to 6, with totals ≥3 scored as positive. These methods of screening for depression and anxiety with the above cut points have been validated previously; the PHQ-2 has a sensitivity of 79% and a specificity of 86% for any depressive disorder, and the GAD-2 has a sensitivity of 86% and a specificity of 83% for generalized anxiety disorder. The PHQ-2 has been validated in adolescent populations as well.
The 4 strength-based questions were summed for this analysis, creating a single "Asset" category to show how protective factors were related to depression and anxiety symptoms in adolescents. Questions related to substance use (alcohol, tobacco, marijuana, and illicit drug use) were scored together as one risk factor because of the frequent overlap in these behaviors.
Data Analysis
The Healthy Teens Screener has two formats: one for younger teens (11 to 14 years old) and one for older adolescents (15 to 21 years old). For the purpose of this study, only questions represented in both iterations were used, allowing for the development of a congruent dataset among the entire study population. The dataset use for the current analysis was limited to 11 to 18 year olds (N = 2184) because of the small numbers in older age groups. Dartmouth Medical School's institutional review board, the Committee for the Protection of Human Subjects at Dartmouth College, approved the study protocol.
For this report, items that potentially are associated with increased likelihood of a positive screen for depression or anxiety were determined from literature review. The next step was to determine the items' association with screening positive for depression or anxiety at the bivariate level. In addition to the strength-based questions, 2 questions about familial and peer psychosocial support were asked. The assets and psychosocial support questions together constitute the protective factors, shielding the adolescents from depression and anxiety.
Our data analysis explored the role that the protective and social risk factors played in determining who screens positive for depression and anxiety. First, bivariate t tests and χ tests were used to establish the set of questions that were associated with positive screens of depression and anxiety. Unadjusted and adjusted logistic regression analyses were then conducted using all the symptoms identified by the bivariate methods, establishing which protective or social risk factors were individual, significant predictors for either screening positive for depression or screening positive for anxiety. All statistical tests were performed using SPSS 18.0 (IBM, Chicago, IL).
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