Interventions for adolescent depression in primary care.
BACKGROUND
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.


OBJECTIVE
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.


METHODS
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.


RESULTS
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.


CONCLUSIONS
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.
Stein
Ruth E K
RE
Department of Pediatrics, Albert Einstein College of Medicine/Children's Hospital at Montefiore, 111 E. 210 St, New York, New York, USA. rstein@aecom.yu.edu
Zitner
Lauren E
LE
Jensen
Peter S
PS
D000293:Adolescent; D000928:Antidepressive Agents / Q000627:therapeutic use; D003131:Combined Modality Therapy; D003419:Crisis Intervention; D003863:Depression / Q000188:drug therapy / Q000628:therapy*; D003866:Depressive Disorder / Q000188:drug therapy / Q000628:therapy*; D004502:Education, Medical, Continuing; D005260:Female; D006801:Humans; D008297:Male; D010349:Patient Compliance; D010372:Pediatrics / Q000193:education; D010817:Physician-Patient Relations; D010821:Physicians, Family / Q000193:education; D011320:Primary Health Care / Q000379:methods*; D011584:Psychology; D000297:Psychology, Adolescent; D011614:Psychotherapy, Brief; D016032:Randomized Controlled Trials as Topic; D012944:Social Support; D016896:Treatment Outcome
D000928:Antidepressive Agents