Sensitivity and Specificity of a Signaling Question for Surveillance of Cognitive Functioning in Pediatric Sickle Cell Disease.

The lifetime prevalence of depression in children aged 3–17 in the United States has increased by between 3.1% and 5.4% annually from 2016 to 2022 and now represents an estimated 5.3% to 7.1% of all children (; ). The growing prevalence of childhood depression has been attributed to several factors, such as familial economic stress (; ), social media use (; ; ), and changes to mental health screening (; ), the last of which has become the focus for health system policymakers in recent times. In this context, the United States (US) Preventive Services Task Force first recommended universal screening for major depressive disorder in adolescents aged 12 to 18 years in 2016 and again in 2022 (; ). Since the USPSTF recommendation, various iterations of pediatric depression and suicide screening protocols have been implemented across whole pediatric hospital systems () and in pediatric clinical settings within the US, such as primary care (; ; ; ; ; ), specialty clinics (; ; ; ; ), and urgent care (). While the implementation of depression screening has demonstrated mostly positive outcomes related to treatment linkage across these settings (; ; ; ), several challenges associated with sustainment were identified, including workflow constraints, limited capacity for follow-ups and referrals, and lack of local champions (; ). Specific to the hospital system level, there are limited data on the implementation of universal depression screening despite high volumes of child and adolescent patients accessing this system annually (). The only large-scale example is a comprehensive pediatric healthcare system in southern California that implemented universal depression screening for all patients aged 12–17 years starting in 2016 (). This system screens adolescents across inand outpatient specialty/medical care units, the emergency department (ED), and urgent and primary care settings. Despite this, implementation gaps were reported, including differential rates of screening across clinics and significant uncertainty around service linkage and treatment access for patients due to referrals from positive screens only being tracked to internal services. Importantly, this study reported that 87.6% of patients who screened positive for depression presented to the ED did so for a non-psychiatric concern, which highlights the importance of the hospital system to the pediatric behavioral health system in the US. As such, an exploration of current practices is needed to elucidate gaps within the depression care cascade across units within this hospital system.