Modeling the Impact of Universal Depression Screening in Middle and High School: A System Dynamics Approach

Despite increases in the rates of depression during adolescence, symptoms of mood disorders frequently go undetected by parents and other adults in youths’ lives (De Leo & Heller, 2004). Universal screening has been demonstrated to increase identification rates for service provision (Scott et al., 2009), and schools represent a key setting in which screening can occur. Nevertheless, few districts routinely screen their students for depressive symptoms (Foster et al., 2005).

Multiple factors influence the extent to which depression screening programs have been implemented in the education sector, including worries about confidentiality, potential iatrogenic effects, and the reliability and validity of screening measures themselves (Fox et al., 2008).  Among the most commonly-referenced barriers are concerns that the students identified may exceed schools’ service delivery capacities. Nevertheless, few studies have addressed this concern systematically. Furthermore, no studies have evaluated the potential utility of different service improvement approaches, which may compensate for the anticipated increase in service need. Approaches include: (a) the services approach, in which the number of providers is increased; and (b) the evidence-based practice (EBP) implementation approach, where the use of high-quality programs is expected to result in faster and more reliable youth improvement.

System dynamics (SD) modeling facilitates quantitative mapping of recursive influences and interdependencies that occur within complex systems (Hirsch et al., 2007). SD modeling allows stakeholders to ethically and cost-effectively explore hypothetical scenarios to guide decision-making and implementation in a manner that is tailored to the local context. Using data drawn from the youth mental health literature and public datasets, the current paper will use SD techniques to model and simulate the impact of a universal depression screening program in a “typical” high school with the goal of identifying system components that may influence service delivery, additional resources that may be needed to facilitate depression screening, and key leverage points that provide efficient opportunities for addressing youth needs. In doing so, the following research questions will be addressed:

(1) What is the anticipated impact of introducing a universal depression screening program on service need and service use?

(2) What are the anticipated effects of two different approaches to compensating for the increased demand that may result from screening? and

(3) What additional data are needed to more effectively model (a) the impact of universal depression screening on school and larger system resources or (b) the effectiveness of compensatory approaches?

Discussion will include identification of potential leverage points to improve efficiency and effectiveness when implementing universal depression screening in schools as well as strengths, limitations and future directions for prevention research efforts.