Low use of primary care, depression screenings by teens with sickle cell
Guidelines recommend screening as part of primary care for adolescents
Many adolescents with sickle cell disease (SCD) aren’t having recommended depression screenings nor regularly visiting their primary care providers (PCPs), even though most have a registered PCP, a study reports.
“Despite a higher overall rate of depression in this population … most youth are not being screened for depression routinely,” the researchers wrote. “Our results … suggest that even those living in low levels of disadvantage may not routinely engage in PCP care, indicating there may be barriers to PCP care beyond socioeconomic constraints.”
The study, “Depression Screening and Primary Care Engagement and Their Association With Socioeconomic Disadvantage Among Adolescents Aged 13–17 Years With Sickle Cell Disease,” was published as a brief report in Pediatric Blood & Cancer.
SCD is a genetic disorder that causes defects in hemoglobin, the protein that helps transport oxygen in red blood cells. This leads to symptoms that may include episodes of severe pain. Teens with SCD are at a higher risk of depression, according to research, which puts pediatric patients at a greater risk of being hospitalized due to pain crises.
“While guidelines recommend screening for depression as part of primary care for all adolescents, our prior work suggests few young adults with SCD see their primary care provider (PCP) or receive depression screening,” wrote the researchers, who investigated how many teens with SCD were regularly receiving depression screenings and visiting PCPs.
Evaluating PCP visits, depression screening
“Socioeconomic disadvantage is a well-described risk factor for developing depression and other adverse health outcomes,” wrote the researchers, who also analyzed if living in a disadvantaged area impacted PCP visits and depression screening.
The study included 88 adolescents with SCD, ages 13-17, who were followed at the Nationwide Children’s Hospital in Ohio for at least one year between 2018 and 2023. Most (63%) had sickle cell anemia, the most common and often the most severe form of SCD.
Nearly all (97%) had PCPs registered in the hospital’s systems. The researchers were able to access medical records for a subset of 55 participants whose PCPs were affiliated with the Nationwide Children’s Hospital.
Most (60%) teens in this subgroup hadn’t visited their PCPs in the previous year. About two-thirds hadn’t been screened for depression using the Patient Health Questionnaire-9 (PHQ-9). Of those who were screened, all but one received the screening from their PCP. Two participants had PHQ-9 scores that indicated potential depression and received referrals to psychiatrists or therapists.
The 55 adolescents in the subgroup were fairly evenly split between levels of socioeconomic disadvantage. This was measured using the Area Deprivation Index (ADI), a geographical database of socioeconomic scores, at each participant’s address.
There was no statistically significant relationship between ADI and recent visits to PCPs or PHQ-9 screening, meaning the hypothesis “that adolescents with SCD living in areas of higher deprivation would be less likely to receive depression screening and PCP care” wasn’t supported by their analysis.
The study had some limitations, including the small sample size, which could affect the generalizability of the results, said the researchers, who also noted it was possible that some participants received depression screening using tools other than the PHQ-9, which was the only one analyzed.
“In conclusion, depression screening and receipt of primary care are suboptimal among young adolescents with SCD,” the researchers wrote. “Future studies that explore strategies to encourage and sustain PCP engagement, even among those with low socioeconomic disadvantage, are warranted, as receipt of primary care and mental health screening … may mitigate SCD complications.”
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