Clinical associations of quarterly Patient Health Questionnaire-9 depression screening results in adolescents with type 1 diabetes

Background Awareness of comorbid depression in type 1 diabetes (T1D) patients is necessary to optimize health and diabetes care. Depression can occur or recur requiring regular review for depression symptoms. A validated tool to screen adolescents for symptoms of depression is the Patient Health Questionnaire (PHQ)-9 Modified for Teens (PHQ9(1-9)). Methods PHQ9(1-9) depression screen results, depression-related ICD-codes, demographic data, and information on complications and comorbidities of adolescents >= 11 years old with T1D were obtained. Longitudinal and single observation multivariable analyses identified associations of covariates with positive PHQ9(1-9) depression screens. Results 5032 PHQ9(1-9) surveys were completed by 1225 unique participants. Overall, 6% (286/5032) of the PHQ9(1-9)depression screens were positive, and 60% (171/286) of the positive screens occurred in 107 unique patients without documented depression. In the longitudinal analysis, positive PHQ9(1-9) screens were associated (P < .05) with a diagnosis of depression listed in the medical record (OR 9.8), diabetic retinopathy (OR 4.3), female sex (OR 1.9), and use of an insulin pump (OR 0.5), while the single observation analysis at the time of a positive PHQ9(1-9) indicated presence of depression in the medical record (odds ratio 12.1), female sex (OR 1.9), and obesity (OR 1.8) were significantly (P < .05) associated with positive PHQ9(1-9) results. Conclusion Quarterly PHQ9(1-9) depression screening of adolescents with T1D during routine clinic visits can immediately inform care, and previous diagnosis of depression is the most strongly associated covariate, highlighting the importance of documenting depression in the medical record. Additionally, awareness for higher odds of positive PHQ9(1-9) depression screens in females, obese adolescent, and patients on insulin injections is important.