4. Characterizing Patients Who Screen Positive On PHQ-4 in a Pediatric Plastic Surgery Office

OBJECTIVE: Depression and anxiety are two diseases on the rise among children in the United States. The Patient Health Questionnaire-4 (PHQ-4) is a self-reported screening tool used to determine a patient’s symptom burden of anxiety and depression, with a “positive” screen denoting the need for additional evaluation for anxiety and depression with the PHQ-9 and GAD-7, which stratify patient’s symptoms of depression and anxiety, respectively, into mild, moderate, or severe. The goal of this study is to gain insight into patient characteristics that lead to higher screening scores in a pediatric plastic surgery office. METHODS: All patients between ages 11-25 that had a completed appointment with a pediatric plastic surgery practice and screened positive (3+) on the PHQ-4 in the past 2 years were identified (n=134). A control group (C) of patients seen over the same period and same age distribution with a completed appointment regardless of PHQ status (n=946) was identified. Demographics were recorded including age, gender, and race. T-tests and Chi-squared tests were performed to compare the two groups, with a statistically significant p-value set at 0.05. RESULTS: 14% of the 11-25-year-old patients seen in the last two years screened positive on the PHQ-4. Patients who screened positive on the PHQ-4 group were older than the control group (16.97 years versus 16.27 years, p=0.01.) In the PHQ+ group the average PHQ-4 score was 6.37, the average PHQ-9 was 14.4, and the average GAD-7 was 12.96. The PHQ+ group was 65.7% female and the control group was 53% female (p<0.01). Racial composition between the two groups were similar. The most common presenting diagnoses in both groups were non-traumatic skin conditions (melanocytic nevi, congenital vascular lesions, hypertrophic scarring) followed by breast hypertrophy, cleft lip and/or palate, and maxillary hypoplasia. Patients with skin conditions, cleft lip and/or palate, and maxillary hypoplasia were present in the PHQ+ group and control group with similar frequency (nonsignificant). Patients presenting with breast hypertrophy were greater represented in the PHQ+ group than the control group (PHQ+=19%, C=11%, p<0.01). CONCLUSION: Patients in a pediatric plastic surgery practice who screen positive on the PHQ-4 were older and more likely to be female. Those in the PHQ+ cohort scored on average between moderate to severe depression and moderate anxiety. Breast hypertrophy was the only diagnosis that was greater represented in the PHQ+ group than the control group. Females with breast hypertrophy are more likely than males with breast hypertrophy to screen positive on the PHQ-4. CORRESPONDING AUTHOR: Benjamin S. Kowalske, 3915 Balmony Commerce Township, MI 48382., [email protected], 734-536-5710.