Depression Screening in Primary Care - Why It's Essential - Nemours Blog


Depression Screening in Primary Care – Why It’s Essential

Depression Screening in Primary Care, Powered by Nemours Children's Health System

Rates of mental health concerns among adolescents, including depression and suicidal thoughts, have risen substantially in recent years. Studies have also shown that the COVID-19 pandemic in the U.S. has disproportionately affected people with low socioeconomic status, as well as Black, Indigenous, and Latino people, all of whom have experienced higher rates of cases, hospitalizations, and deaths.

According to, about 20 percent of all teens experience depression before they reach adulthood, but only about 30 percent of teens are being treated for their symptoms.

Pediatric primary care is an important setting for routine mental health screening among adolescents. The American Academy of Pediatrics (AAP) recommends universal screening by primary care providers for all patients 12 years of age and older at their annual well visits. Depression screenings are important because signs can often be missed if they are not obvious to untrained individuals

Kids who are in distress often don’t speak up, but they might if we ask the right questions. What seems like typical teen angst or moodiness may need to be addressed by a physician or mental health professional.

Contributing Factors to Depression

It is important to recognize teens who might be more at risk for developing symptoms of depression than others. Here are some known factors that contribute to depression:

  • Female teens develop depression twice as often than males.
  • Abused and neglected teens are especially at risk.
  • Adolescents who suffer from chronic illnesses or other physical conditions are at risk.
  • Teens with a family history of depression or mental illness
    • between 20 to 50 percent of teens suffering from depression have a family member with depression or some other mental disorder.
  • Teens with untreated mental or substance-abuse problems
    • approximately two-thirds of teens with major depression also battle another mood disorder like dysthymia (mild low-mood persisting for more than 2 years), anxiety, antisocial behaviors, or substance abuse.
  • Young people who experienced trauma or disruptions at home, including divorce and deaths of parents.
  • LGBTQ young people are more than twice as likely to feel suicidal, and over four times as likely to attempt suicide, compared to heterosexual youth.
  • Transgender youth are far more likely than their non-transgender peers to experience depression.

Incorporating mental health screening into a child’s regular primary care visit can be relatively easy by asking a few simple questions.

Depression Screening Tool

Nemours Children’s Health uses the Patient Health Questionnaire-9 (PHQ-9), a quick nine-question screening tool that assesses suicidal ideation and the primary symptoms of depression such as:

  • sadness or irritability
  • feelings of hopelessness
  • loss of pleasure
  • difficulties with sleep or eating

The screening tool is built into the Nemours Children’s Health electronic health record, so it automatically alerts primary care providers to assess for risk at well-child visits for youth 12 years or older. Children and teens who are identified as at risk for depression are often referred to the integrated behavioral health provider in the practice, sometimes right on the spot.

Screening Works

Screenings for mental health disorders are as important as any other physical checkup. Depression screenings are often the first step towards getting help. Not only is clinical depression identified as a medical illness, but it can also lead to much more serious conditions if not treated, such as suicidal thoughts. The sooner a diagnosis of depression is made, the sooner a treatment plan can be developed to help your child recover just like they would with any other illness.

If you think your child might be depressed or has a problem with moods, schedule a visit to your child’s pediatrician as soon as possible.

Learn More

Kids and Suicide: Know the Warning Signs and How to Help (Nemours Blog)
Anxiety in Kids: Know the Signs (Nemours Blog)

Meghan McAuliffe Lines, PhD

Meghan McAuliffe Lines, PhD, is a Clinical Director of Integrated Primary Care Psychology, at Nemours Children's Hospital in Wilmington, Del.