Poster 366: EVALUATION OF A DEPRESSION SCREENING PROGRAM IN PEDIATRIC ORTHOPAEDIC SPORTS CLINICS: WHICH PATIENTS ARE IDENTIFIED AS AT RISK?

Abstract

Objectives:

Universal depression screening of patients ≥12 years of age was instituted at our facility in 2018 in an effort to combat the suicide rate among teenagers. The purpose of this study was to quantify the significance of depression in adolescents being treated within a sports clinic at a pediatric institution and attempt to identify predictors of at risk patients.

Methods:

A retrospective review was performed to identify all patients, ages 12-21 years, who were administered the Patient Health Questionnaire (PHQ-2/PHQ-9) over a 2-year period within our pediatric orthopaedic sports clinics. Patients were grouped into four broad diagnostic categories; knee instability, knee other, other sports related, or shoulder injury. The rate of a positive screen prompting administration of PHQ9 (PHQ2>3), rate of depression risk (PHQ9≥10), and rate of patients indicating self-harm were evaluated. Multivariate binary logistic regression to identify available demographic and diagnosis predictors of risk of self-harm was performed.

Results:

There were 3,298 patients screened in orthopedic sports clinics from 2018-2021. The overall rate of positive screens was 4.2% (n=138), rate of depression risk was 1.9% (n=63), and self-harm was 0.9% (n=29). The distribution of these rates for each diagnostic category are seen in Table 1. Self-harm showed a significant difference in the proportion at risk across the four diagnostic categories (p=0.038), with shoulder and knee instability having the highest rate. Black or African American race (OR 3.8, 95% CI 1.3-11, p=0.02), female gender (OR 3 95%CI 1.3-6.9, p=0.01), public/government insurance (OR 3.8, 95% CI 1.3-11, p=0.02), shoulder diagnosis (OR 3.5 95%CI 1.3-9.4, p=0.016), and knee instability diagnosis (OR 2.8 95%CI 1.2-6.5, p=0.02) were associated with increased risk of self-harm.

Conclusions:

This study demonstrated a 2% rate of depression risk and 1% rate of self-harm risk in this adolescent population being treated within sports clinics. Variability in rate of risk was identified, with the shoulder and knee instability patients having higher risk profiles. Aside from diagnosis groups, gender, race, and insurance were factors that were also independently predictive of patients at risk for depression or self-harm. Knowledge of risk factors can help increase awareness and recognition of potential mental health conditions that may need addressing during the course of treatment for the sports-related injury.