Final Research Plan
Depression in Children and Adolescents: Screening
September 15, 2013
Recommendations made by the USPSTF are independent of the U.S. government. They should not be construed as an official position of the Agency for Healthcare Research and Quality or the U.S. Department of Health and Human Services.
The final Research Plan will be used to guide a systematic review of the evidence by researchers at an Evidence-based Practice Center. The resulting Evidence Report forms the basis of the USPSTF Recommendation Statement on this topic.
The draft Research Plan was available for comment from May 30 until June 26, 2013 at 5:00 p.m., ET.
- Does screening for major depressive disorder (MDD) in children and adolescents in the primary care (or comparable) setting lead to improved health and other related outcomes overall and in subgroups defined by age, sex, or race/ethnicity?
- Are depression screening instruments for children and adolescents accurate in identifying MDD in primary care settings overall and in subgroups defined by age, sex, or race/ethnicity?
- Does screening increase the proportion of patients identified with MDD overall and in subgroups defined by age, sex, or race/ethnicity?
- What are the harms of screening for MDD in children and adolescents overall and in subgroups defined by age, sex, or race/ethnicity?
- Does treatment of MDD in children and adolescents identified in primary care improve health and other related outcomes overall and in subgroups defined by age, sex, or race/ethnicity?
- What are the harms of treatment of MDD in children and adolescents overall and in subgroups defined by age, sex, or race/ethnicity?
These key questions (KQs) reflect important changes since the 2009 review. All questions explicitly incorporate a subquestion on subgroups. In addition to the subgroup of primary interest in the 2009 review (age), these questions explicitly ask about sex and race/ethnicity subgroups.
Contextual questions will not be systematically reviewed and are not shown in the Analytic Framework.
Valid and reliable risk stratification tools may enhance the U.S. Preventive Services Task Force’s (USPSTF’s) ability to provide targeted recommendations for risk groups. Contextual information on uptake of existing recommendations may help tailor updated recommendations. Risk factors and uptake of USPSTF recommendations will be addressed via the following contextual questions.
- What proportion of primary care providers assess, treat, and refer child and adolescent patients with depression (MDD, dysthymia, and minor depression)? What proportion of providers have access to collaborative systems of care for these patients?
- What are the most common types of treatment of MDD in children and adolescents that can be initiated in or referred from primary care settings?
- Is there evidence of valid and reliable risk stratification tools to identify children and adolescents at high risk for MDD?
- In primary care, school, or comparable settings, are children and adolescents with MDD and comorbid mental health (e.g., attention deficit hyperactivity disorder, anxiety disorders) or chronic physical health conditions (e.g., diabetes, asthma) more likely to be screened, treated, or referred for treatment than children and adolescents with MDD only? Do they receive different treatment than children and adolescents without comorbid conditions?
- Is there evidence of effectiveness of serotonin–norepinephrine reuptake inhibitors (SNRIs), norepinephrine-dopamine reuptake inhibitors (NDRIs), or complementary and alternative medicine (CAM) treatments for child and adolescent MDD?
The Research Approach identifies the study characteristics and criteria that the Evidence-based Practice Center will use to search for publications and to determine whether identified studies should be included or excluded from the Evidence Report. Criteria are overarching as well as specific to each of the KQs.
Inclusion | Exclusion | |
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Populations |
KQs 1–4: Children and adolescents age 18 years or younger who are representative of a population seen in a primary care setting
KQs 5, 6: Children and adolescents age 18 years or younger who are representative of a population seen in a primary care or similar setting identified with MDD |
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Interventions: Screening |
|
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Interventions: Treatment |
Pharmacological interventions:
Psychotherapy interventions:
Other interventions:
Combined interventions:
|
Pharmacological interventions:
Other therapy:
|
Comparisons |
KQs 1, 3, 4:
KQ 2:
KQ 5:
KQ 6:
|
KQs 1, 3–6:
|
Outcomes |
KQ 1:
Primary outcomes of interest:
Additional outcomes of interest:
KQ 2:
KQ 3:
KQ 4:
KQ 5: Primary outcomes of interest
Additional outcomes of interest
KQ 6: Suicidality or death
|
KQs 1, 3, 4–6: All other outcomes not listed in inclusion criteria |
Timing |
KQs 1, 3, 5: Outcomes reported at 6-week followup or later
KQ 2: Diagnostic accuracy compared with an independent standard, assessed at ≤2 months after the screening test |
KQs 1, 3, 5: Outcomes reported earlier than 6 weeks following screening or treatment
KQ 2: Diagnostic accuracy compared with an independent standard, assessed at >2 months after the screening test |
Settings |
KQs 1, 3:
KQs 2, 4:
KQs 5, 6:
|
KQs 1, 3:
KQs 2, 4:
KQs 5, 6:
|
Study Designs |
KQs 1, 3, 4–6:
Criteria specific to KQ 2:
Criteria specific to KQ 4:
Criteria specific to KQ 6:
|
KQs 1, 3, 4–6:
Criteria specific to KQs 1, 3:
Criteria specific to KQ 2:
Criteria specific to KQ 4:
Criteria specific to KQ 6:
|
Language | English | Non-English |
Date of Publication | Any date subsequent to the latest date searched in the prior review | Any date included in the prior review |
The draft Research Plan was posted for public comment on the USPSTF Web site from May 30 to June 26, 2013. In response to comments, the USPSTF clarified the target group to be screened for depression in primary care and removed the lower age limit to also include children younger than age 7 years. The revised Research Plan also more clearly defines the focus on screening and treatment of major depressive disorder and specifies settings that are appropriate to answer each key question. The majority of the population must be representative of a primary care population; thus, the Research Plan excludes studies in which a majority of the participants have a comorbid physical or mental illness. The USPSTF added severity of depression as an outcome and split the second contextual question into two separate questions. Finally, the classes of interventions will be grouped into “pharmacologic” versus “psychotherapeutic” and other interventions.