坚持青少年抑郁症筛查实践取向

龚雯洁; 曾榛; 张丽; 胡宓; 童永胜

doi:10.16835/j.cnki.1000-9817.2022.05.015

坚持青少年抑郁症筛查实践取向

doi: 10.16835/j.cnki.1000-9817.2022.05.015

龚雯洁^{1, 2},
曾榛¹,
张丽³,
胡宓⁴,
童永胜⁵

1.
中南大学湘雅公共卫生学院儿少卫生与妇幼保健学系, 湖南长沙 410078
2.
伯明翰大学应用卫生研究院/罗切斯特大学医学中心
3.
湖南省妇幼保健院心理卫生科
4.
中南大学湘雅公共卫生学院社会医学与卫生事业管理系
5.
北京回龙观医院(北京心理危机研究与干预中心)

基金项目:

国家自然科学基金项目 81973059

详细信息

作者简介:
龚雯洁(1979-)，女，湖南长沙人，博士，教授，主要研究方向为妇幼保健和心理卫生

曾榛(1987-), 女, 广西桂林人, 在读博士, 主要研究方向为妇幼保健和心理卫生

利益冲突声明 所有作者声明无利益冲突。
龚雯洁和曾榛为共同第一作者。
中图分类号: B844.2 R179 G478
计量
- 文章访问数: 952
- HTML全文浏览量: 432
- PDF下载量: 68
- 被引次数: 0
出版历程
- 收稿日期: 2021-12-09
- 修回日期: 2022-01-20
- 网络出版日期: 2022-05-20
- 刊出日期: 2022-05-25

Objectives of screening for depression in adolescents

1.
Department of Maternal and Child Health, Xiangya School of Public Health, Central South University, Changsha (410078), China

摘要

摘要: 抑郁症是影响青少年身心健康的重要公共卫生问题, 教育部提出将其筛查纳入学生体检作为青少年抑郁症防治工作的一环, 但目前各国及不同组织对青少年抑郁症常规筛查的推荐等级及执行细节等问题存在诸多不同意见。研究概述了青少年抑郁的流行现况和危险因素, 总结国外相关指南及推荐意见, 提出开展基于学校体检的青少年抑郁症筛查仍需社会各界深入密切协作, 在厘清筛查科学性、工作运行、资源配置和伦理等关键问题的基础上, 实行"试点先行, 分步实施, 家校配合"的策略, 以实现促进青少年心理健康水平提高的最终目的。
- 抑郁症 /
- 精神卫生 /
- 健康促进 /
- 青少年
Abstract: Depression is a major public health issue among adolescents. The Ministry of Education of China recently proposed to integrate depression screening into students' school health-check among adolescents. However, there are inconsistencies regarding the strength of recommendation and implementation details of routine screening for adolescent depression across professional organizations and countries. This paper outlines the epidemiology and risk factors of adolescent depression and summarizes relevant international guidelines and recommendations. We suggest that before the national implementation of school-based depression screening, key issues including scientific evidence, execution details, resource allocation and ethical considerations need to be examined in close collaboration with all stakeholders. Systematic piloting followed by rigorous evaluation will also be needed.
- Depressive disorder /
- Mental health /
- Health promotion /
- Adolescent
注释:

1) 利益冲突声明 所有作者声明无利益冲突。

2) 龚雯洁和曾榛为共同第一作者。

HTML全文

表 1 国外机构组织对青少年抑郁筛查的推荐

Table 1. Recommendations for adolescent depression screening by various of organizations in different countries

组织	年份	筛查实施者	筛查对象	筛查方式或工具	筛查时间点	对筛查阳性者的措施
美国预防服务工作组	2016	—	12~18岁	PHQ-A、BDI (primary care version)	—	根据抑郁症的严重程度和其他考虑因素，如青少年的生活状况、其他健康状况和治疗偏好，由临床医生、青少年和其父母共同决定治疗方案
美国妇产科医师学会	2017	妇产科医生或门诊医生	9~17岁	PHQ-A、PHQ-2	—	将患者转诊至精神卫生保健专家或机构进行进一步评估和治疗，并随访
澳大利亚家庭医生	2017	全科医生	5~12岁	学龄前感受清单、MFQ、CDI-2	—	正式的心理干预和转诊、药物治疗
美国儿科学会	2018	初级保健的儿科医生	10~21岁	采用可靠的抑郁筛查量表和临床访谈	每年对≥12岁的青少年进行体检	评估后，联合初级保健临床医师和家庭对患者进行诊疗
英国国家卫生与临床优化研究所	2019	基层保健人员进行风险识别与评估；儿童青少年心理健康服务系统(2~4级医疗)的保健人员对基层转诊对象进行常规筛查	5~18岁：风险识别与评估>11岁：转诊至心理健康服务系统后开展常规筛查	基于证据的社会、情感和行为筛查工具	—	评估、监测、随访、干预、治疗，分级诊疗
美国儿童和青少年精神病学学会	2019	初级保健提供者或心理健康临床医生	≥8岁	—	—	对儿童/青少年和家庭进行有关青少年抑郁症的教育，并对儿童进行治疗或转诊治疗
注：PHQ-A为青少年健康问卷；BDI为贝克抑郁量表初级保健版；PHQ-2为病人健康问卷-2；MFQ为情绪与感受问卷；CDI-2为儿童抑郁量表-2。

下载: 导出CSV

参考文献(34)

[1]	WHO. Adolescent mental health[EB/OL]. (2021-11-17)[2021-11-25]. https://www.WHO.int/news-room/fact-sheets/detail/adolescent-mental-health.
[2]	THAPAR A, COLLISHAW S, PINE D S, et al. Depression in adolescence[J]. Lancet, 2012, 379(9820): 1056-1067. doi: 10.1016/S0140-6736(11)60871-4
[3]	MILLER L, CAMPO J V. Depression in adolescents[J]. N Engl J Med, 2021, 385(5): 445-449. doi: 10.1056/NEJMra2033475
[4]	JOHNSON D, DUPUIS G, PICHE J, et al. Adult mental health outcomes of adolescent depression: a systematic review[J]. Depress Anx, 2018, 35(8): 700-716. doi: 10.1002/da.22777
[5]	国家卫生健康委员会. 关于印发健康中国行动——儿童青少年心理健康行动方案(2019—2022年)的通知[A/OL]. (2019-12-26)[2021-11-25]. http://www.nhc.gov.cn/jkj/tggg1/201912/6c810a8141374adfb3a16a6d919c0dd7.shtml. National Health Commission of the PRC. Healthy China Action—mental health action plan for children and adolescents[EB/OL]. (2019-12-26)[2021-11-25]. http://www.nhc.gov.cn/jkj/tggg1/201912/6c810a8141374adfb3a16a6d919c0dd7.shtml.
[6]	国家卫生健康委员会. 解读《探索抑郁症防治特色服务工作方案》[A/OL]. (2020-09-11)[2021-11-25]. http://www.gov.cn/zhengce/2020-09/11/content_5542560.htm. National Health Commission of the PRC. Interpretation on work plan of an explorative study on the featured services for the prevention and treatment of depression[A/OL]. (2020-09-11)[2021-11-25]. http://www.gov.cn/zhengce/2020-09/11/content_5542560.htm.
[7]	教育部. 关于政协第十三届全国委员会《关于进一步落实青少年抑郁症防治措施的提案》答复的函[EB/OL]. (2021-10-25)[2021-11-13]. http://www.moe.gov.cn/jyb_xxgk/xxgk_jyta/jyta_twys/202111/t20211104_577685.html. Ministry of Education of the PRC. Response to proposal of the 13th National Committee of the Chinese People's Political Consultative Conference on preventing depression among teenage students[EB/OL]. (2021-10-25)[2021-11-13]. http://www.moe.gov.cn/jyb_xxgk/xxgk_jyta/jyta_twys/202111/t20211104_577685.html.
[8]	POLANCZYK G V, SALUM G A, SUGAYA L S, et al. Annual research review: a Meta-analysis of the worldwide prevalence of mental disorders in children and adolescents[J]. J Child Psychol Psychiatry, 2015, 56(3): 345-365. doi: 10.1111/jcpp.12381
[9]	XU D D, RAO W W, CAO X L, et al. Prevalence of major depressive disorder in children and adolescents in China: a systematic review and Meta-analysis[J]. J Affect Disord, 2018(241): 592-598.
[10]	LI J Y, LI J, LIANG J H, et al. Depressive symptoms among children and adolescents in China: a systematic review and Meta-analysis[J]. Med Sci Monit, 2019, 25: 7459-7470. doi: 10.12659/MSM.916774
[11]	RACINE N, MCARTHUR B A, COOKE J E, et al. Global prevalence of depressive and anxiety symptoms in children and adolescents during COVID-19: a Meta-analysis[J]. JAMA Pediatr, 2021, 175(11): 1142-1150. doi: 10.1001/jamapediatrics.2021.2482
[12]	SALK R H, HYDE J S, ABRAMSON L Y. Gender differences in depression in representative national samples: Meta-analyses of diagnoses and symptoms[J]. Psychol Bull, 2017, 143(8): 783-822. doi: 10.1037/bul0000102
[13]	侯金芹, 陈祉妍. 青少年抑郁情绪的发展轨迹: 界定亚群组及其影响因素[J]. 心理学报, 2016, 48(8): 957-968. https://www.cnki.com.cn/Article/CJFDTOTAL-XLXB201608005.htm HOU J Q, CHEN Z Y. The developmental trajectory of adolescent depression: defining subgroups and their influencing factors[J]. Acta Psychol Sinica, 2016, 48(8): 957-968. https://www.cnki.com.cn/Article/CJFDTOTAL-XLXB201608005.htm
[14]	ZISOOK S, LESSER I, STEWART J W, et al. Effect of age at onset on the course of major depressive disorder[J]. Am J Psychiatry, 2007, 164(10): 1539-1546. doi: 10.1176/appi.ajp.2007.06101757
[15]	WEERSING V R, JEFFREYS M, DO M C T, et al. Evidence base update of psychosocial treatments for child and adolescent depression[J]. J Clin Child Adolesc Psychol, 2017, 46(1): 11-43. doi: 10.1080/15374416.2016.1220310
[16]	MVHLIG Y, ANTEL J, FÖCKER M, et al. Are bidirectional associations of obesity and depression already apparent in childhood and adolescence as based on high-quality studies?A systematic review[J]. Obes Rev, 2016, 17(3): 235-249. doi: 10.1111/obr.12357
[17]	QUEK Y H, TAM W W S, ZHANG M W B, et al. Exploring the association between childhood and adolescent obesity and depression: a Meta-analysis[J]. Obes Rev, 2017, 18(7): 742-754. doi: 10.1111/obr.12535
[18]	RAO W W, ZONG Q Q, ZHANG J W, et al. Obesity increases the risk of depression in children and adolescents: results from a systematic review and Meta-analysis[J]. J Affect Disord, 2020(267): 78-85.
[19]	MCLEOD B D, WEISZ J R, WOOD J J. Examining the association between parenting and childhood depression: a Meta-analysis[J]. Clin Psychol Rev, 2007, 27(8): 986-1003. doi: 10.1016/j.cpr.2007.03.001
[20]	YAP M B H, PILKINGTON P D, RYAN S M, et al. Parental factors associated with depression and anxiety in young people: a systematic review and Meta-analysis[J]. J Affect Disord, 2014(156): 8-23.
[21]	TANG X, TANG S, REN Z, et al. Psychosocial risk factors associated with depressive symptoms among adolescents in secondary schools in mainland China: a systematic review and Meta-analysis[J]. J Affect Disord, 2020(263): 155-165.
[22]	HUGHES K, BELLIS M A, HARDCASTLE K A, et al. The effect of multiple adverse childhood experiences on health: a systematic review and Meta-analysis[J]. Lancet Public Health, 2017, 2(8): e356-e366. doi: 10.1016/S2468-2667(17)30118-4
[23]	WU Y L, ZHAO X, LI Y F, et al. The risk and protective factors in the development of childhood social anxiety symptoms among Chinese children[J]. Psychiatry Res, 2016(240): 103-109.
[24]	SIU A L. Screening for depression in children and adolescents: U.S. preventive services task force recommendation statement[J]. Ann Int Med, 2016, 164(5): 360. doi: 10.7326/M15-2957
[25]	NICE. Depression in children and young people: identification and management[J/OL]. (2019-06-25)[2020-09-10]. http://www.ncbi.nlm.nih.gov/books/NBK547251/.
[26]	ZUCKERBROT R A, CHEUNG A, JENSEN P S, et al. Guidelines for adolescent depression in primary care[J]. Pediatric, 2018, 141(3): e20174081. doi: 10.1542/peds.2017-4081
[27]	ACOG. Mental health disorders in adolescents[EB/OL]. (2017-07-27)[2021-11-25]. https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2017/07/mental-health-disorders-in-adolescents.
[28]	国家统计局. 2019年《中国儿童发展纲要(2011—2020年)》统计监测报告[R/OL]. (2020-12-18)[2021-11-25]. http://www.stats.gov.cn/tjsj/zxfb/202012/t20201218_1810128.html. National Bureau of Statistics of China. 2019 statistical monitoring report on the Implementation of China National Program for Children's Development(2011-2020)[R/OL]. (2020-12-18)[2021-11-25]. http://www.stats.gov.cn/tjsj/zxfb/202012/t20201218_1810128.html.
[29]	TANG X, TANG S, REN Z, et al. Prevalence of depressive symptoms among adolescents in secondary school in mainland China: a systematic review and Meta-analysis[J]. J Affect Disord, 2019(245): 498-507.
[30]	RAO W W, XU D D, CAO X L, et al. Prevalence of depressive symptoms in children and adolescents in China: a Meta-analysis of observational studies[J]. Psychiatry Res, 2019, 272: 790-796. doi: 10.1016/j.psychres.2018.12.133
[31]	LI F, CUI Y, LI Y, et al. Prevalence of mental disorders in school children and adolescents in China: diagnostic data from detailed clinical assessments of 17, 524 individuals[J]. J Child Psychol Psychiatry, 2021. DOI: 10.1111/jcpp.13445.
[32]	李傲雪, 张云淑, 栗克清. 国内儿童及青少年抑郁测评工具的研究进展[J]. 中国全科医学, 2017, 20(35): 4464-4469. doi: 10.3969/j.issn.1007-9572.2017.00.094 LI A X, ZHANG Y S, LI K Q. Recent developments in assessment tools for depression in children and adolescents in China[J]. Chin Gen Pract, 2017, 20(35): 4464-4469. doi: 10.3969/j.issn.1007-9572.2017.00.094
[33]	SEKHAR D L, SCHAEFER E W, WAXMONSKY J G, et al. Screening in high schools to identify, evaluate, and lower depression among adolescents: a randomized clinical trial[J]. JAMA Netw Open, 2021, 4(11): e2131836. doi: 10.1001/jamanetworkopen.2021.31836
[34]	WU J L, PAN J. The scarcity of child psychiatrists in China[J]. Lancet Psychiatry, 2019, 6(4): 286-287.