Primary Care, Depression, and Anxiety: Exploring Somatic and Emotional Predictors of Mental Health Status in Adolescents

Children's Hospital, Boston, MA, USA.
The Journal of the American Board of Family Medicine (Impact Factor: 1.98). 05/2012; 25(3):291-9. DOI: 10.3122/jabfm.2012.03.110056
Source: PubMed


A growing body of research points to regular, comprehensive mental health screening in primary care practices as an effective tool, but a thorough and efficient approach is not yet widely used. The purpose of this report is to describe the pattern of mental health-related concerns, protective and social risk factors reported by adolescents during routine well-child visits in primary care settings, and their occurrence among teens that screen positive for either depression or anxiety with brief validated measures.
A personal digital assistant-based questionnaire was administered as part of clinical care to adolescents 11 to 18 years old (N = 2184) attending preventive well-child visits in 13 pediatric and family medicine primary care practices in a northern New England practice-based research network over 18 months (2008 to 2009). Depressive and anxiety-related symptoms were assessed using the 2-question versions of the Patient Health Questionnaire and Generalized Anxiety Disorder scale, respectively. Analyses determined the role that the protective and social risk factors played in determining who screens positive for depression and anxiety.
In the fully adjusted model, risk factors that were significant (P < .05) predictors for a positive screen of depression included substance use (adjusted odds ratio [AOR], 2.05); stress (AOR, 3.59); anger (AOR, 1.94); and worries about family alcohol and drug use (AOR, 2.69). Among protective factors, that is, those that reduce the risk of depression, age (AOR, 0.87 for younger patients); having parents who listen (AOR, 0.34); and having more assets (AOR, 0.65) were significant. Significant predictors of screening positive for anxiety included substance use (AOR, 1.97); stress (AOR, 6.10); anger (AOR, 2.31); trouble sleeping (AOR, 1.75), and the sex of the adolescent (AOR, 1.87 for girls). Although having parents who listen was still a significant protective factor for anxiety (AOR, 2.26), other assets were not significant.
Comprehensive primary care mental health screening that considers both anxiety and depression while including strength-based and psychosocial support questions is a helpful adjunct to clinical practices and has been done routinely by using an electronic tool at the point of care. Because certain common somatic and emotional concerns can precede depression and anxiety, routine screening for these issues along with depression and anxiety screening is suggested.

3 Reads
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: In this diverse issue, we have a report on the high cost of diabetes quality improvement programs. Two studies using health information technology, including one that embedded a questionnaire and tool for bipolar disorder into an electronic health record to improve diagnosis, and another that collected information about anxiety and depression for adolescents with a personal digital assistant. Other articles considered sources of disparities in screening for colorectal cancer in rural Georgia, and the characteristics of sepsis in HIV patients. Clinicians will likely find interesting how patients interpret and report provider reactions to interpersonal violence situations. We also have a review of the symptoms patients report in a community practice sample; breast cancer survivors' perspectives on acupuncture for treating hot flashes; clinical reviews about Alzheimer disease and prasugrel; and several interesting brief case reports.
    The Journal of the American Board of Family Medicine 05/2012; 25(3):263-5. DOI:10.3122/jabfm.2012.03.120068 · 1.98 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Parental behaviors, emotions, and cognitions are known to influence children's response to pain. However, prior work has not tested the association between maternal psychological factors and children's responses to a conditioned pain modulation (CPM) task. CPM refers to the reduction in perceived pain intensity for a test stimulus following application of a conditioning stimulus to a remote area of the body, and is thought to reflect the descending inhibition of nociceptive signals. The present study examined sex differences in the association between maternal anxiety about pain and children's CPM responses in 133 healthy children aged 8-17 years. Maternal pain anxiety was assessed using the Pain Anxiety Symptoms Scale-20. In addition to the magnitude of CPM, children's anticipatory anxiety and pain-related fear of the CPM task were measured. Sequential multiple linear regression revealed that even after controlling for child age and general maternal psychological distress, greater maternal pain anxiety was significantly related to greater CPM anticipatory anxiety and pain-related fear in girls, and to less CPM (ie, less pain inhibition) in boys. The findings indicate sex-specific relationships between maternal pain anxiety and children's responses to a CPM task over and above that accounted for by the age of the child and the mother's general psychological distress.
    Journal of Pain Research 03/2013; 6:231-8. DOI:10.2147/JPR.S43172
  • [Show abstract] [Hide abstract]
    ABSTRACT: Abstract Background: Several studies have demonstrated that age and sex may influence concussion recovery time frames, with female athletes and adolescents being potentially more susceptible to a protracted recovery course. Currently, limited work has examined the influence sex may have on concussion management strategies and treatment interventions, especially for younger individuals suffering persistent concussion symptoms and cognitive dysfunctions. Hypothesis: Female athletes are prescribed more treatment interventions than male athletes during a protracted recovery from a concussion. Study Design: Descriptive epidemiology study. Level of Evidence: Level 4. Methods: Data were retrospectively collected for adolescent athletes presenting to a sports medicine concussion clinic between September 2010 and September 2011. Results: A total of 266 adolescent athletes were evaluated and treated for concussion. Female athletes had a longer recovery course (P = 0.002) and required more treatment interventions (P < 0.001) for their symptoms and dysfunction. Female athletes were more likely to require academic accommodations (P < 0.001), vestibular therapy (P < 0.001), or medication (P < 0.001). Conclusion: Medical providers should be aware that during the recovery course, adolescent female athletes may require a management plan that will most likely include additional treatment interventions beyond the standard cognitive and physical rest. Clinical Relevance: Treatment interventions are more commonly prescribed for adolescent female athletes than for adolescent male athletes during a protracted recovery from a concussion. This highlights the need for identifying evidence-based clinical management guidelines that focus on sex, especially when dealing with persistent concussion symptoms and cognitive dysfunctions.
    Sports Health A Multidisciplinary Approach 01/2015; 7(1):52-57. DOI:10.1177/1941738114555075
Show more