Nearly one in five youth with childhood-onset systemic lupus erythematosus screened positive for moderate to severe depressive symptoms, with 9% reporting suicidal ideation, according to a recent study.
Researchers at Vanderbilt University Medical Center reported the successful implementation of a standardized depression screening process for youth with childhood-onset systemic lupus erythematosus (cSLE) in their pediatric rheumatology clinic. The study, published in Pediatric Rheumatology, employed quality improvement (QI) methodology to increase screening rates from 0% to 81% over three years, achieving sustained results through an electronic health record (EHR)-driven system.
The study analyzed 592 completed screenings out of 661 assigned screenings from 886 eligible patient encounters between September 2019 and December 2022. Using the Patient Health Questionnaire-9 modified for adolescents (PHQ-A) during routine follow-up visits, researchers identified moderate to severe depressive symptoms in 17% of patients, with 9% exhibiting suicidal ideation. Among the 21 patients flagged for suicidal ideation, 100% received appropriate interventions during the early phases, including social work assessments, safety planning, and emergency department referrals. After automation, 92% received interventions due to initial programming errors that were promptly resolved.
Key interventions included integrating pre-visit patient identification into the EHR, automating PHQ-A assignment, and developing best practice advisory alerts for suicidal ideation. Automation reduced reliance on clinic staff, enhancing sustainability and reliability. Providers and patients expressed high satisfaction with the system, emphasizing its role in normalizing mental health discussions.
The authors noted that this study is the first to implement a fully automated EHR-driven depression screening process in a pediatric rheumatology setting, demonstrating its potential for broader application. While limitations included the exclusion of non-English-speaking patients and satellite clinics, the findings underscore the importance of routine mental health screenings in improving care for youth with chronic conditions. Researchers advocate for further studies to evaluate the impact of mental health interventions on disease outcomes and encourage the adoption of automated processes in other subspecialty care settings.
Full disclosures can be found in the published study.
