New recommendations for anxiety, depression screening for children; UPMC launches digital tool

Oct. 31—The U.S. Preventative Services Task Force recently recommended depression screenings for kids 12 to 18 and anxiety screenings for kids 8 to 18.

Dr. Dana Gadaire, a pediatric psychologist at Geisinger, said the recommendations had been a long time coming. In related news, a team of investigators from UPMC Children's Hospital of Pittsburgh found that a digital application may remove barriers to mental health care and is associated with reduced emotional distress when offered as part of routine pediatric care.

"The better question is why has it taken so long?" said Gadaire about the task force's recent recommendations. "The rates of depression and suicide have been increasing. The children we're seeing diagnosed with depression and at risk of suicide have been getting younger and younger. COVID has only exacerbated the trends we've seen for several years already."

Health care is multi-faceted that must include all concerns, whether it's physical, mental, or emotional, she said.

"If we don't know about emotional well beings and social factors affecting patients' health, then we really can't provide state-of-the-art health care or even quality health care," she said. "It backs up what many providers are already doing. It reminds providers that this is part of your job. You have to pay attention to all these factors."

Depression screenings 12 and up are consistent with what the American Academy of Pediatrics recommends. Primary care should be screening for all of these things on a regular basis. This formalizes those recommendations, said Gadaire.

"We've been seeing an explosion of school-aged children, adolescents and young adults with anxiety, social anxiety, general anxiety, panic, as well as depression, and related symptoms that don't always get diagnosed as depression or anxiety," she said. "Thematic complaints, interpersonal difficulties, cognitive issues that can be symptoms but don't get recognized or get misdiagnosed."

Younger children may not be able to vocalize their emotions. They may show irritability and emotional volatility. They may show thematic complaints, such as stomach aches, headaches, and difficulty in starting their day in the morning, she said.

Questionnaire

Most providers give a questionnaire to both the young patients and their parents. It asks whether they have noticed symptoms in themselves or their child in order to give two perspectives. Those answers are combined and a risk score is derived, said Gadaire.

Any child age 12 or older is directly asked the following questions: have they considered killing themselves? Do you have a plan to do so? Do you have the means to carry out that plan?

"If they endorse any of those, we will obviously direct them immediately to get help," said Gadaire.

The biggest barriers to doing these screenings are lack of time and overscheduled providers. Geisinger has resources in the form of Gadaire and her colleagues to be there in crisis situations; patients can be referred to them after a primary care physician's screening, she said.

"Geisinger is already ahead of the eight-ball when it comes to developmental and psychiatric screening," she said.

UPMC findings

The findings from the team of investigators from UPMC Children's Hospital of Pittsburgh were published in Psychiatric Services. These findings were made possible by YourMomCares (YMC), a kids' mental health nonprofit founded by the moms of musicians, athletes and actors, which fully funded the study. The results of Phase 1 along with the devasting rising suicide statistics amongst children in this county, led YourMomCares to fully fund an expanded study of the app, including suicidal ideation, according to UPMC.

UPMC initially studied RxWell, a digital application developed by UPMC Health Plan to support its members with the management of depression and other health and wellness challenges and published positive outcomes in adult users. This project with YourMomCares in 2019 was the first to evaluate RxWell as part of routine care for adolescents and young adults, ages 16 to 22. The groundbreaking app offers real-time coping techniques to users, enhanced with personal health coaching to aid improvement, according to UPMC.

Dr. Eva Szigethy, professor of psychiatry, pediatrics and medicine at the University of Pittsburgh, director of behavioral health within the UPMC Health Services Division and the lead for the app pilot, said the app reduces the stigma of mental health treatment for young people.

"The fact you can download something and have it available and not have to go to a doctor's office is a particular appeal to the younger generation," said Szigethy. "Second, the ease of use and immediacy of its availability. The second you download it, you're getting a message from your coach, getting access to the techniques and start interacting with the app right away. The younger generation really likes that app in your pocket."

Connecting to coaches

RxWell can be downloaded from Google or Apple online stores. It is available for patients with a UPMC health membership plan for free.

Patients connect to health coaches employed with UPMC who can motivate patients, personalize the techniques and skills, and communicate with patients. The app consists of a set of more than 80 cognitive behavioral and mindfulness skills that are pushed to the patients depending on whether the patient has anxiety or depression, said Szigethy.

Patients can track their progress and get real-time feedback on their targets and improving their scores, said Szigethy.

"Adolescents are used to having this as a form of communication. They're more digitally savvy and they're more in their comfort zones," she said.

Szigethy said these digital tools are not a replacement for primary care providers or licensed behavioral clinicians.

"It can certainly ease some of the access issues," she said. "It can empower patients to work on some of these skill developmental changes and maladaptive habits autonomous from a clinical visit, yet still be guided by a coach. It's better to think of it as an enhancer and extender of medical care, not a replacement of medical care for anxiety or depression."

506 prescribed

The app was prescribed in late 2019 to 506 adolescents and young adults at 35 pediatric practices, with 278 young people ultimately enrolling. Of those, 58 percent engaged with the app and 63 percent messaged their coach.

In follow-up interviews, randomly selected app users said they were most likely to use the app when they were anxious or in stressful situations, emphasizing the benefits of the app provides a "real person" to give accountability and reassurance.

The preliminary results indicated that 73 percent of app users saw a reduction in anxiety and 57 percent saw reduced depression.

With the additional $1.24 million gift from YourMomCares, an expanded study that also includes a focus on suicidal ideation has been launched testing more patients and expanding the geographic reach of the app through partnerships in Boston and San Diego.

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