Depression prevalence, screening, and treatment rates in adolescents with obesity in ambulatory settings

• Depression is under-identified and under-screened for in adolescents with obesity • Depression predictors are related to gender, chronic conditions, and physician visits • Significantly different rates of counseling and psychotherapy in those with low BMI This study aims to describe the prevalence, screening, and treatment rates for depression in adolescents in ambulatory settings in the United States. Physician-reported data on 444,080,295 male and female adolescents ages 13-18 were extracted from the 2008-2018 CDC National Ambulatory Medical Care Survey datasets. Body mass index (BMI) percentiles were calculated using the CDC’s SAS calculator, and particpants were then stratified into weight groups based on their BMI percentiles. Statistical testing included T-test and chi-square to determine association between weight groups and depression, and regression analysis was used to determine predictors of depression. Weighting factors were applied to improve comparability and reduce bias. 16.89% of participants had obese BMI percentiles, and 13.81% had overweight, 43.39% had healthy, and 25.91% had underweight BMI percentiles. Depression screening rates in adolescents with obesity is 2.89%, overweight is 3.35%, healthy weight is 3.49%, and underweight is 2.83% ( p =0.382). Prevalence of depression in adolescents with obesity is 7.17%, overweight is 6.04%, healthy weight is 6.31%, and underweight is 12.14% ( p <0.0001). Prevalence of counseling and psychotherapy in adolescents with obesity is 2.70%, overweight is 2.89%, healthy weight is 2.92%, and underweight is 11.27% ( p <0.0001). Patients seen by primary care health workers, age, female sex, number of chronic conditions, and increased visits are significant predictors of depression diagnosis in adolescents. Depression in adolescents with overweight or obese status is under-screened for, under-identified, and under-treated. More mental health counseling and psychotherapy must be offered to those with both depression and obesity.