Expert survey for the management of adolescent depression in primary care.
OBJECTIVE
Primary care clinics have become the "de facto" mental health clinics for teens with mental health problems such as depression; however, there is little guidance for primary care professionals who are faced with treating this population. This study surveyed experts on key management issues regarding adolescent depression in primary care where empirical literature was scant or absent.


METHODS
Participants included experts from family medicine, pediatrics, nursing, psychology, and child psychiatry, identified through nonprobability sampling. The expert survey was developed on the basis of information from focus groups with patients, families, and professionals and from the research literature and included sections on early identification, assessment and diagnosis, initial management, treatment, and ongoing management. Means, standard deviations, and confidence intervals were calculated for each survey item.


RESULTS
Seventy-eight of 81 experts agreed to participate (return rate of 96%). Fifty-three percent of the experts (n = 40) were primary care professionals. Experts endorsed routine surveillance for youth at high risk for depression, as well as the use of standardized measures as diagnostic aids. For treatment, "active monitoring" was deemed appropriate in mild depression with recent onset. Medication and psychotherapy were considered acceptable options for treatment of moderate depression without complicating factors such as comorbid illness. Fluoxetine was rated as the most appropriate antidepressant for use in this population. Finally, experts agreed that patients who are started on antidepressants should be followed within 2 weeks after initiation.


CONCLUSIONS
Survey results support the identification and management of adolescent depression in the primary care setting and, in specific situations, referral and co-management with specialty mental health professionals. Even with the recent controversies around treatment, experts across primary care and specialty mental health alike agreed that active monitoring, pharmacotherapy with selective serotonin reuptake inhibitors, and psychotherapy can be appropriate under certain clinical circumstances when initiated within primary care settings.
Cheung
Amy H
AH
Department of Psychiatry, University of Toronto, 33 Russell St, Third Floor Tower, Toronto, Ontario, M5S 2S1, Canada. amy_cheung@camh.net
Zuckerbrot
Rachel A
RA
Jensen
Peter S
PS
Stein
Ruth E K
RE
Laraque
Danielle
D
D000293:Adolescent; D000294:Adolescent Behavior; D000328:Adult; D000928:Antidepressive Agents / Q000008:administration & dosage*; D001291:Attitude of Health Personnel; D003131:Combined Modality Therapy; D003866:Depressive Disorder / Q000175:diagnosis* / Q000628:therapy*; D005260:Female; D017144:Focus Groups; D005500:Follow-Up Studies; D019538:Health Care Surveys; D006801:Humans; D008297:Male; D009483:Neuropsychological Tests; D010818:Practice Patterns, Physicians'; D011320:Primary Health Care / Q000592:standards* / Q000639:trends; D011569:Psychiatric Status Rating Scales; D011613:Psychotherapy / Q000379:methods; D018570:Risk Assessment; D017749:Total Quality Management; D016896:Treatment Outcome
D000928:Antidepressive Agents