Comparing Universal versus Targeted School Screenings for Depression among Teens -- The SHIELD Trial

Project Summary This research project is in progress. PCORI will post the research findings on this page within 90 days after the results are final. In the meantime, results have been published in peer-reviewed journals, as listed below. What is the research about? Over the past decade, the rate of major depressive disorder, or MDD, among teens in the United States increased by more than 50 percent. MDD increases the risk for suicide, the second leading cause of death among teens. Many treatment options exist for MDD, but few teens are screened for MDD during healthcare visits. Screening rates are even lower among those who belong to racial or ethnic minority groups. More teens may get screened for MDD, and receive diagnosis and treatment, if screening takes place in schools. This study is comparing the effectiveness of two methods for screening teens for MDD in schools: Universal screening, where all students get screened Targeted screening, where students with concerning behavior get screened The research team wants to learn whether universal screening increases the number of teens who are found to have MDD and get care for it. They also want to see whether it reduces differences in how often students get care for MDD across race and ethnicity. Who can this research help? School systems and policy makers may be able to use these findings when considering how to identify MDD and improve access to treatment for MDD among teens. What is the research team doing? The research team is working with Pennsylvania public high schools that serve mostly minority, urban, or low-income students. The team is enrolling at least 9,650 students in the study. The team is assigning students by grade level within each high school to receive either universal or targeted MDD screenings by chance. Students assigned to universal screening complete a mental health questionnaire at the start of the school year. Students who screen positive for MDD meet with their school's Student Assistance Program, or SAP. The SAPs conduct further assessments and, if needed, recommend follow-up services or treatment. Students assigned to targeted screening follow the schools' standard process for identifying MDD. Students with concerning behavior are referred to the SAP. The research team is tracking the percentage of students who screen positive for MDD, get recommendations for follow-up services or treatment from the SAP, and take part in at least one recommended service or treatment for MDD. They are also tracking signs of success in school such as grade point average, standardized test scores, and graduation rates. The team is comparing the effectiveness of each type of screening by race, ethnicity, and sex. School staff, parents, and adolescents are helping the research team plan and carry out the study. Research methods at a glance Design Elements Description Design Randomized clinical trial Population 9,650 students attending public high schools in Pennsylvania Interventions/ Comparators Universal MDD screening Targeted MDD screening Outcomes Primary: percentage of students who screen positive for MDD, are confirmed to require follow-up, and receive at least one recommended service or treatment Secondary: positive MDD screenings, SAP-confirmed need for student follow-up, suicidal thoughts, standardized test scores, school policy violations, school absences, grade point average, grade advancement, graduation Timeframe More InformationTimeframe Length of follow-up for collecting data on primary outcomes. View GlossaryClose Up to 9-month follow-up for primary outcomes