Interventions for Adolescent Depression in Primary Care

Department of Psychiatry, Columbia University, New York, New York, United States
PEDIATRICS (Impact Factor: 5.47). 09/2006; 118(2):669-82. DOI: 10.1542/peds.2005-2086
Source: PubMed


Depression in adolescents is underrecognized and undertreated despite its poor long-term outcomes, including risk for suicide. Primary care settings may be critical venues for the identification of depression, but there is little information about the usefulness of primary care interventions.
We sought to examine the evidence for the treatment of depression in primary care settings, focusing on evidence concerning psychosocial, educational, and/or supportive intervention strategies.
Available data on brief psychosocial treatments for adolescent depression in primary settings were reviewed. Given the paucity of direct studies, we also drew on related literature to summarize available evidence whether brief, psychosocial support from a member of the primary care team, with or without medication, might improve depression outcomes.
We identified 37 studies relevant to treating adolescent depression in primary care settings. Only 4 studies directly examined the impact of primary care-delivered psychosocial interventions for adolescent depression, but they suggest that such interventions can be effective. Indirect evidence from other psychosocial/behavioral interventions, including anticipatory guidance and efforts to enhance treatment adherence, and adult depression studies also show benefits of primary care-delivered interventions as well as the impact of provider training to enhance psychosocial skills.
There is potential for successful treatment of adolescent depression in primary care, in view of evidence that brief, psychosocial support, with or without medication, has been shown to improve a range of outcomes, including adolescent depression itself. Given the great public health problem posed by adolescent depression, the likelihood that most depressed adolescents will not receive specialty services, and new guidelines for managing adolescent depression in primary care, clinicians may usefully consider initiation of supportive interventions in their primary care practices.

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    • "Primary care providers (PCPs) are well-positioned to improve the recognition and treatment of depression among children and adolescents, given the frequency with which this population sees their PCPs and their comfort in discussing health behavior concerns with their clinicians [7]. Interventions delivered to depressed adolescents by PCPs and within the primary care setting have demonstrated effectiveness [8•]. "
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    ABSTRACT: Depression is a common condition among children and adolescents, with lasting detrimental effects on health, and social and occupational functioning. Despite being well-positioned to treat depression, primary care providers (PCPs) cite significant barriers. This review aims to summarize recent evidence to provide practical guidance to PCPs on the management of pediatric depression in their practices. Following identification and assessment, PCPs should provide general initial management. Children and adolescents with mild depression can be managed with active support and symptom monitoring, while those with moderate-to-severe depression can be treated with psychotherapy and/or antidepressants, which may involve referral to mental health specialty care. Less is known about the treatment of depression in children under the age of 12 years, who may be candidates for earlier referral to mental health specialty care. PCPs have the potential to improve the recognition and management of depression in young people, having lasting individual and societal benefits.
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    • "Department of Health and Human Services, 2001; Harrington, 2002; Kessler et al., 2003). Despite these poor long-term outcomes, depression in adolescents continues to be underrecognized, undertreated , and stigmatized (Cheng et al., 1993; Walker et al., 2002; Stein et al., 2006; Zuckerbrot et al., 2007a; 2007b). According to the National Survey on Drug Use and Health, 60% of adolescents who reported having at least one depressive episode in the previous year failed to receive adequate treatment for their depression (Substance Abuse and Mental Health Services Administration, 2004). "
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    ABSTRACT: Background Studies have established that many depressed adolescent patients do not receive optimal mental health care. Specifically, depression in primary-care settings is underrecognized, undertreated, and stigmatized. Although the seriousness and prevalence of adolescent depression is well known to primary-care physicians, its assessment, diagnosis, and treatment remains a significant problem in general and in rural communities in particular.Aims and discussion In this article, the author accomplishes three aims: (1) summarizes the most current evidence-based guidelines for depression care for adolescents in primary-care settings, (2) reviews the empirical literature on how key patient demographic variables (race, gender, and age) may be correlated with and predictive of variations in evidence-based depression care (assessment, diagnosis, and treatment) for adolescent patients, particularly in rural areas, and (3) provides implications for translating empirical research findings to evidence-based depression care in rural primary-care settings.
    Full-text · Article · Sep 2010 · Primary Health Care Research & Development
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    • "Major depression is most often treated with individual psychotherapy,106 pharmacotherapy, or a combination of both modalities. Cognitive-behavioral therapy (CBT) appears to be more effective for the treatment of depression than other individual psychotherapies,60,107 eg, primary care psychosocial support.108 Because adolescents tend to attribute their problems to external factors, eg, family dysfunction,29 they are likely to prefer psychotherapy.65,109 "
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    ABSTRACT: When treatments are ordered for adolescent major depression, or for other adolescent medical illnesses, adherence and clinical outcomes are likely to be unsatisfactory, unless 4 basic principles of the medical treatment of adolescent illness are implemented. These comprise providing effective patient and parent/caregiver education, establishing effective patient and caregiver therapeutic alliances, providing effective treatment, and managing other factors associated with treatment adherence as indicated. The goals of treatment are to achieve the earliest possible response and remission. Failure to treat adolescent major depression successfully has potentially serious consequences, including worsened adherence, long-term morbidity, and suicide attempt. Accordingly, prescribed treatment must be aggressively managed. Doses of an antidepressant medication should be increased as rapidly as can be tolerated, preferably every 1-2 weeks, until full remission is achieved or such dosing is limited by the emergence of unacceptable adverse effects. A full range of medication treatment options must be employed if necessary. Treatment adherence, occurrence of problematic adverse effects, clinical progress, and safety must be systematically monitored. Adolescents with major depression must be assessed for risk of harm to self or others. When this risk appears significant, likelihood of successful outcomes will be enhanced by use of treatment plans that comprehensively address factors associated with treatment nonadherence. Abbreviated and comprehensive plans for the treatment of potentially fatal adolescent illnesses are outlined in this review.
    Preview · Article · Aug 2010 · Adolescent Health, Medicine and Therapeutics
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