Adolescent Mental Health Assessment in Family Medicine and Specialty Settings in Appalachian Upstate South Carolina to Include Sexting Frequency and Depression Indices.

Sexting is associated with adolescent depression. This study aimed to expand provider assessment in Family Medicine and specialty settings in Appalachian Upstate South Carolina (AUSC) to include sexting and depression screening. AUSC depression rates are among the highest in the nation, highlighting disparities in the region. This nurse-led mixed-method, exploratory descriptive study included adolescents 11 to 18 years old and providers from an AUSC healthcare system, including nurse researchers, nurse practitioners, and physicians. Following education on sexting, depression, and screening, providers in Family Medicine and specialty settings administered the Intimate Images Diffusion Scale and PHQ-2 to adolescents at episodic visits. Concurrently, providers completed a survey on the barriers and facilitators to talking with parents/guardians (P/G) and adolescents about sexting with each participant, including provider comments. Providers also gave P/G a sexting education notebook to take with them. Surveys were analysed using SPSSv24 statistical software, and comments were analysed using thematic analysis. Over 50% screened positive for sexting, and over 40% of those who sexted screened positive for depression. Providers reported few barriers, with P/G (71.9%) and adolescents (81.3%) talking about sexting. The themes were P/G openness to conversations about sexting, P/G awareness of sexting risks, P/G concerns about sexting, adolescent openness to conversations about sexting, and provider facilitators and barriers to discussing sexting. Provider education and screening is a crucial first step in identifying adolescent sexting and depression. Screening in Family Medicine and specialty settings in rural, underserved areas may lead to earlier diagnosis and treatment and improved patient outcomes.