School-based screening can improve both identification and initiation of treatment.


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The proportion of adolescents who have experienced a major depressive episode has steadily risen in recent years, nearly doubling from 8.3% in 2008 to 14.4% in 2018. The COVID-19 pandemic and accompanying social isolation measures have only exacerbated the situation, adding new demands on an already taxed health care system.


According to a 2021 report by the office of the assistant secretary for planning and evaluation of the U.S. Department of Health and Human Services, following a COVID-19 diagnosis, adolescents were nearly 4.5 times more likely to experience depression than affected children ages six to 11 (37.9% versus 8.6%)-a finding noted in the report as "particularly concerning due to the link between depression and suicidal ideation." Adverse childhood experiences-including child abuse and neglect, the loss of a family member, addiction in families, and such psychosocial events as criminal proceedings-substantially increased the odds of young people experiencing a mental health condition.


Even before COVID-19, the mental health of teenagers and the inadequacy of identification and treatment were a growing concern. A 2019 study by the National Institute of Mental Health sought to quantify and categorize U.S. adolescents ages 12 to 17 most at risk. The researchers found that about 3.8 million or 15.7% of this age group had experienced at least one major depressive episode and that the prevalence was significantly higher among girls (23%) than boys (8.8%), and highest among racially mixed teens (nearly 21%). But of those experiencing depression, only 43.3% reported receiving treatment.


The emerging mental health consequences of COVID-19 have added urgency to the need to find and treat adolescents experiencing depression and potentially avert development of lifelong mental illness. A study published November 5, 2021, in JAMA Network Open of school-based screening found it to be an effective tool to identify major depressive disorders among teens and steer them to appropriate treatment. From November 2018 to November 2020, the researchers randomized nearly 13,000 students in 14 public high schools in Pennsylvania to two groups: one receiving universal screening through the completion of the Patient Health Questionnaire-9 (a depression screening tool), the other continuing with the existing practice of relying on staff members to identify students with depression-related behavior-a method known as targeted student referral. The students who received universal screening were nearly six times more likely than those in the targeted group to have depression symptoms identified. They were also twice as likely to initiate treatment.


Several states-including Utah, New York, and New Jersey-have introduced or passed bills requiring school-based screening for depression. Robin Cogan, a nationally certified school nurse, faculty at the Rutgers University-Camden School of Nursing, and member of AJN's editorial board, said the requirement is now law in New Jersey but implementation has not yet begun. According to Cogan, even before the pandemic, mental health concerns consumed a significant portion of school nurses' time, a demand now "greatly amplified as the pandemic continues to impact what is now our third school year." Cogan told AJN that a colleague recently described her role as "50% contact tracing and 50% addressing the mental health needs of students and staff."


The Substance Abuse and Mental Health Services Administration has a tool kit called Ready, Set, Go, Review: Screening for Behavioral Health Risk in Schools to help schools implement effective behavioral health screening. For more information, visit: http://www.samhsa.gov/sites/default/files/ready_set_go_review_mh_screening_in_sc.-Dalia Sofer