Effectiveness of Universal versus Targeted School Screening for Adolescent Major Depressive Disorder -- The SHIELD Trial

Suicide is now the second leading cause of adolescent death. The prevalence of annual major depressive disorder (MDD) episodes has increased by over 50 percent from 2008 to 2015 among US adolescents. Unfortunately, despite recommendations for universal MDD screening, screening occurs in less than 2 percent of office visits. Further, screening is 80 percent less likely for Hispanic compared with non-Hispanic white adolescents, and both minorities and females are less likely to receive MDD treatment. The primary goal of the proposed study is to compare the effectiveness of universal versus targeted adolescent MDD screening in a school setting.

Universal screening was chosen to be conducted in schools because, compared with medical settings, schools are more likely to engage adolescents representing a broad spectrum of race, ethnicity, and socioeconomic status. We hypothesize that universal school-based screening with the validated Patient Health Questionnaire-9 will increase the number of adolescents identified with MDD and engaged in treatment, and reduce disparities by race, ethnicity, and sex in adolescent mental health. Our Penn State University team brings a breadth of experience in pediatrics, community-engaged research, adolescent health, psychiatry, and engagement with minority populations. We have actively partnered with school staff, parents, and adolescents in designing a randomized controlled trial with eight Pennsylvania public high schools serving an estimated 9,650 predominantly minority, rural, and/or low-socioeconomic-status ninth- through 12th-grade students to conduct the proposed research.

We anticipate the proposal results will provide clear support for universal or targeted screening as an optimal approach to adolescent depression and inform best practices for management of adolescent MDD. The results have high potential for dissemination from the local to the national level. Results will be shared directly with partnering schools (e.g., school website, newspaper, social media); at the state level with over 1,000 schools across Pennsylvania by utilizing the Penn State Pro Wellness newsletter and our ongoing relationships with the Pennsylvania Student Assistance Program, Prevent Suicide Pennsylvania and the Pennsylvania Department of Health; and at the national level through the investigative team’s academic circles as well as through our collaboration with the National Poll on Children’s Health.