School screening for depression mooted

SCHOOL-based delivery of screening for early signs of depression in adolescents would be a cost-effective move in Australia, health economists say.

Policy makers should “seriously consider” a program whereby a brief screening tool is administered in schools and psychologists can deliver appropriate interventions such as cognitive behavioural therapy (CBT), the experts said.

Australian researchers, including high profile mental health intervention evaluator Professor Jane Pirkis from the University of Melbourne, modelled such an intervention based on the 2003 Australian population of 11- to 17-year-olds and evaluated it using outcomes from a meta-analysis.

The psychological interventions were largely CBT-based and delivered by psychologists in group format, although the authors suggested internet-delivered services may also be cost-effective.

Dr Nick Kowalenko, chair of the faculty of child and adolescent psychiatry at RANZCP, agreed there was potentially a role in mild cases of depression, but said that hard evidence was not yet in.

He believes there is a strong case for programs targeting children and adolescents with emerging symptoms. 

“There’s a very clear-cut theoretical base,” he said, citing recent Australian research.

“It seems that treatment of depression in adolescence is effective for suicide prevention into young adulthood.”

Professor Ian Hickie, director of the Brain and Mind Research Institute, Sydney, has been outspoken in the past about his concerns that screening will not improve outcomes unless there is access to good treatment pathways.

But he sees potential for that to change as technology makes interventions more affordable and accessible.

“The whole process is likely to be really cost-effective when based on internet rather than counsellor or psychologist delivered services, and that is where we are headed in Australia,” he said.

School children should be targeted for screening only “if you have the infrastructure – personnel or e-health – to respond”, he said.

The authors of the cost-effectiveness study acknowledged potential challenges, including apprehension from schools, teachers and parents.

However the idea “represents very good value for money”, the researchers said, finding only 2% of iterations would fall above an acceptable $50,000 per disability-adjusted life-year threshold.

Dr Kowalenko, investigator in the rollout of a screening and intervention trial in schools across two states, believes it can be done. 

“All these things are achievable. There were no problems we couldn’t overcome, although it does take dedicated conflict resolution and working in partnership,” he said. 

Pediatrics 2012, online 6 Feb