O2034: The Unexpected Impact of the COVID Pandemic on Depression Screening Rates in Adolescents in an Outpatient Clinic

Background: With the ongoing COVID-19 pandemic, child and adolescents' daily lives shifted significantly. Many communities around the country reported an increase in depression in adolescents associated with the COVID-19 pandemic. We conducted a study in our clinic to evaluate the incidence of depressive symptoms during the COVID-19 pandemic quarantine and compared them to pre-pandemic and post-quarantine time points.

Methods: The study was a retrospective chart review done at the Pediatric clinic at TTUHSC in El Paso, Texas.
Our patient population included adolescent’s age 12-18-years that completed a Patient Health Questionnaire (PHQ-9) to screen for depression during their wellness visit. A score of > 5 is considered as a positive screen for depression (5-9 is classified as mild, 10-14 moderate, 15-19 moderately severe and 20-27 severe depression) 9.
We looked at three specific time periods for this study: Pre-COVID (March 2018-April 2020), COVID-Quarantine (April 2020-December 2020) when social distancing measures were implemented and Post-Quarantine (January 2021-May 2021) when schools reopened in our community.

Results: A total of 2716 charts were reviewed: 1596 in the Pre-COVID period, 431 in the COVID-Quarantine period and 689 patients in the Post-Quarantine period.
Results show that the overall patient population coming in during the COVID-Quarantine and Post-Quarantine era was younger (Pre-COVID mean age 13.9, COVID-Quarantine 12.9 and Post-Quarantine 12.5 years.)
When analyzing the binary PHQ-9 outcome (positive vs negative), we found a statistical significance in the number of females that scored positive for depression versus males throughout all time periods. We did not find a statistically significant difference when comparing the Pre-COVID period to the COVID-Quarantine/Post-Quarantine periods combined.
We did see a statistical significance with less positive cases during the COVID-Quarantine period compared to the Pre-COVID and Post-Quarantine periods. There was no significant difference between Pre-COVID and Post-Quarantine scores. When looking at categories of depression, there is a significant increase in the post COVID-Quarantine scores in the moderately severe and severe scores between those time periods.

Conclusion: Our hypothesis that positive PHQ-9 screenings would increase during the COVID-Quarantine and Post-Quarantine periods was not fully supported by the data. We found less positive screenings during the COVID-Quarantine period. Once patients returned to school, screening scores went up to numbers closer to Pre-COVID period but when the time periods were stratified, more patients scored in the moderately severe and severe categories during the Post-Quarantine period compared to the Pre-COVID period.
This points to the possibility that staying home may have provided protective factors against depressive symptoms during the pandemic and that returning to in-person school removed these protective factors increasing academic stressors, peer pressures and fears related to the pandemic. Looking further to identify these protective factors may uncover ways to help combat the mental health epidemic left by the COVID-19 pandemic.