590 - Experience of, and Screening for, Social Risks, Anxiety and Depression among Adolescents Receiving Care from a Network of School-Based Health Centers in New Mexico

Publication Number: 590.4944

Nathan Tran, University of California, San Francisco, School of Medicine, San Francisco, CA, United States; Matthew S. Pantell, University of California, San Francisco, School of Medicine, San Francisco, CA, United States; Samira Soleimanpour, University of California, San Francisco, School of Medicine, San Francisco, CA, United States; Emilia De Marchis, University of California, San Francisco, School of Medicine, San Francisco, CA, United States

Background: School-Based Health Centers (SBHCs) play a vital role in providing a health care safety-net, including mental health services, to students from socioeconomically disadvantaged backgrounds. Yet, there is limited research on how SBHCs screen for and address social risk factors (i.e., provide social care). Emerging research suggests that health care-based social care may improve health outcomes, yet the relationship between social care and adolescent mental health is understudied.

Objective: To evaluate 1) screening reach, including rates of screening for social risks and mental health and factors associated with being screened for social risks, and 2) associations between social risks and anxiety and depression, among adolescents in SBHCs.

Design/Methods: We analyzed data from a network of SBHCs in New Mexico that utilize a standardized social risk and mental health screening platform, Just HealthTM. We included data from 3/1/2018-3/1/2022 for adolescents aged 12-18 at the time of their most recent screen. Just HealthTM screens for 4 social risks (food insecurity, housing instability, social isolation, interpersonal partner violence), anxiety (GAD-7) and depression (PHQ-9). We evaluated differences and associations in 1) having documented screening, 2) screening positive for 1+ social risk factor, and 3) screening positive for anxiety and/or depression using chi-squared and multivariable logistic regression analyses. Co-variates included participant demographics and insurance type.

Results: 5,789 adolescent patients were included from 17 SBHCs. 3,234 (58.5%) identified as female. 1,727 (29.8%) had documented social risk screening; 514 (8.9%) screened positive for 1+ social risk. 1,314 (22.7%) and 1,610 (27.8%) had completed screenings for anxiety and depression, respectively; 301 (5.2%) and 318 (5.5%) screened positive, respectively. (Table 1) In multivariable analysis, patients were less likely to be screened for social risk factors if they were male (aOR: 0.89, p=0.043) or uninsured (aOR: 0.60, p< 0.001). Patients positive for 1+ social risks had higher rates of screening positive for anxiety and depression (47.4% vs. 11.5% positive and 45.7% vs. 8.6% positive, respectively, p< 0.001) (Table 2).

Conclusion(s): Adolescent patients who screened positive for 1+ social risk had higher rates of anxiety and depression. Lower rates of documented social risk screening among male and uninsured adolescents raises equity concerns. While screening for both social risks and mental health were low, increasing support for screenings and associated interventions may improve adolescent health outcomes.

Table 1: Demographics and Rates of Screening for 1) Social Risks, 2) Anxiety, and 3) Depression in 5,789 Adolescents at 17 School-Based Health Centers


Table 2: Chi-squared Analyses of Social Risks and Mental Health among those Screened


Figure 1: Logistic Regression Results by Model and Demographic
Odds ratios were calculated for each demographic category for 4 models: (1) Likelihood to be screened for social risk factors, (2) Likelihood to be screened for anxiety, (3) Likelihood to be screened for depression, and (4) Likelihood to have 1+ social risk factors when screened, * p < 0.05, ** p < 0.01, *** p < 0.001