Emergency health services use and medically-treated suicidal behaviors following depression screening among adolescents: A longitudinal cohort study

Abstract

The primary goal of depression screening is to reduce adverse psychiatric outcomes, which may have downstream implications for reducing avoidable health services use. The objective of this study was to examine the association of depression screening with emergency health services use and medically-treated suicidal behaviors among adolescents in the U.S. This longitudinal cohort study used insurance claims data from 57,732 adolescents who had at least one well-visit between 2014 and 2017. Propensity score matching was used to compare adolescents who were screened for depression to similar adolescents who were not screened for depression during the well-visit. Outcomes were examined over two-year follow-up and included emergency department use and inpatient hospitalizations for depression-related reasons, mental health-related reasons, and any reason as well as medically-treated suicidal behaviors. Log-binomial regression models were used to examine associations between depression screening and each outcome in the matched sample. Heterogeneity of associations by sex was examined with interaction terms. Being screened for depression was not consistently associated with emergency department use (depression-related reasons: RR = 1.00, 95% CI = 0.76–1.30; mental health-related reasons: RR = 1.02, 95% CI = 0.80–1.29; any reason: RR = 0.96, 95% CI = 0.83–1.11), inpatient hospitalizations (depression-related reasons: RR = 1.05, 95% CI = 0.84–1.31; mental health-related reasons: RR = 1.16, 95% CI = 1.00–1.33; any reason: RR = 1.05, 95% CI = 0.99–1.12), or medically-treated suicidal behaviors (RR = 0.83, 95% CI = 0.51–1.36). Associations were similar in magnitude among male and female adolescents. The results of this study suggest that depression screening, as it is currently practiced in the U.S., may not deter avoidable health services use among adolescents.