Perceived barriers to treatment for adolescent depression.
OBJECTIVE
Adolescent depression is common, disabling, and is associated with academic, social, behavioral, and health consequences. Despite the availability of evidence-based depression care, few teens receive it, even when recognized by primary care clinicians. Perceived barriers such as teen worry about what others think or parent concerns about cost and access to care may contribute to low rates of care. We sought to better understand perceived barriers and their impact on service use.


METHODS
After completing an eligibility and diagnostic telephone interview, all depressed teens and a matched sample of nondepressed teens recruited from 7 primary care practices were enrolled and completed telephone interviews at baseline and 6 months (August 2005-September 2006).


METHODS
Three hundred sixty-eight adolescent patients aged 13 to 17 (184 depressed and 184 nondepressed) and 338 of their parents.


METHODS
Perceived barriers to depression care and use of services for depression (psychotherapy and antidepressant medication).


RESULTS
Teens with depression were significantly more likely to perceive barriers to care compared with nondepressed teens. Parents were less likely to report barriers than their teens; perceived stigma and concern about family member response were among the significant teen barriers. Teen perceived barriers scores were negatively associated with any use of antidepressants (P < 0.01), use of antidepressants for at least 1 month (P < 0.001), and any psychotherapy or antidepressant use (P < 0.05) at 6 months.


CONCLUSIONS
To improve treatment for adolescent depression, interventions should address both teen and parent perceived barriers and primary care clinicians should elicit information from both adolescents and their parents.
RAND Corporation, Santa Monica, California 90407-2138, USA. lisa_meredith@rand.org
Lisa S
LS
Meredith
Bradley D
BD
Stein
Susan M
SM
Paddock
Lisa H
LH
Jaycox
Virginia P
VP
Quinn
Anita
A
Chandra
Audrey
A
Burnam
D000328:Adult; D000928:Antidepressive Agents / Q000627:therapeutic use; D003376:Counseling / Q000379:methods; D003866:Depressive Disorder / Q000523:psychology / Q000628:therapy*; D005260:Female; D006297:Health Services Accessibility; D006801:Humans; D008297:Male; D010290:Parents; D011320:Primary Health Care; D012737:Sex Factors; D012959:Socioeconomic Factors
D000928:Antidepressive Agents