Lower Completion of Depression Screening and Higher Positivity Among Autistic Adolescents Across a Large Pediatric Primary Care Network.

This large study looked at depression screening in over 60,000 teenagers during routine doctor visits. Autistic teens were less likely to complete depression screening questionnaires compared to non-autistic teens. However, when autistic teens did complete the screening, they were much more likely to show signs of depression and thoughts of suicide. This suggests autistic teenagers may face barriers to mental health screening but have higher mental health needs when properly assessed.

This retrospective cohort study examined depression screening patterns among 60,181 adolescents (ages 12-17) in pediatric primary care, comparing autistic and nonautistic youth during well-child visits from November 2017 to January 2019. The study found that autistic adolescents were significantly less likely to complete depression screening (67.0% vs 78.9%) but when screened, showed higher rates of positive depression screens (39.1% vs 22.8%) and suicidal ideation/behavior (13.4% vs 6.8%). The research utilized PHQ-9-M screening data extracted from electronic health records and employed logistic regression to identify associated factors. Results suggest systematic disparities in both screening completion and mental health outcomes among autistic youth in primary care settings.

Primary care providers should implement strategies to improve depression screening completion among autistic adolescents while being prepared for higher rates of positive results. Enhanced suicide risk assessment protocols may be needed for this population. Understanding barriers to screening completion is essential for developing targeted interventions.

The study is retrospective and limited to one healthcare network, potentially affecting generalizability. Factors contributing to lower screening completion rates are not fully explored. The study does not examine long-term outcomes following positive screens or the effectiveness of subsequent interventions.

To examine rates of depression screening and positivity among autistic adolescents where electronic depression screening is administered universally; to compare rates between autistic and nonautistic youth; and to explore sociodemographic and clinical factors associated with screening completion and results. We conducted a retrospective cohort study comparing 12-17-year-old autistic and nonautistic adolescents presenting for well-child care in a large pediatric primary care network between November 2017 and January 2019 (N = 60,181). Sociodemographic and clinical data, including PHQ-9-M completion status and results, were extracted digitally from the electronic health record and compared between autistic and nonautistic youth. Logistic regression explored the relationship between sociodemographic and clinical factors and screen completion and results, stratified by autism diagnosis.

Autistic adolescents were significantly less likely to have a completed depression screen compared to nonautistic adolescents [67.0% vs 78.9%, odds ratio (OR) = 0.54, P < .01]. Among those with a completed screen, a higher percentage of autistic youths screened positive for depression (39.1% vs 22.8%; OR = 2.18, P < .01,) and suicidal ideation/behavior (13.4% vs 6.8%; OR = 2.13, P < .01). Factors associated with screening completion and positivity differed between autistic and nonautistic groups. Autistic adolescents were less likely to have a completed depression screen when presenting for well-child care.

However, when screened, they were more likely to endorse depression and suicide risk. This suggests disparities in depression screening and risk among autistic youth compared to nonautistic youth. Additional research should evaluate the source of these disparities, explore barriers to screening, and examine longitudinal outcomes of positive results among this population.