Use of a standardized patient paradigm to enhance proficiency in risk assessment for adolescent depression and suicide.
OBJECTIVE
Although routine adolescent depression and suicide risk assessment (ADSRA) is recommended, primary care physician (PCP) ADSRA training is needed for successful ADSRA implementation. This study examined the effect of an intervention using standardized patients (SPs) on PCP ADSRA confidence, knowledge, and practices.


METHODS
The intervention consisted of a 60-minute seminar followed by a 60-minute SP session to practice ADSRA skills in simulated clinical situations.


METHODS
PCPs (n = 46) completed pre- and postintervention assessments. Untrained PCPs interested in the intervention (n = 58) also completed assessments. Assessments evaluated ADSRA self-reported confidence and practices and objectively assessed knowledge. The main outcomes were (1) changes in pre-/postintervention PCP ADSRA confidence and knowledge, and (2) ADSRA practices in untrained versus postintervention PCPs.


RESULTS
Compared with untrained PCPs, PCPs 5-10 months postintervention were more likely to screen most adolescents for depression (40% vs. 22%, p = .05), to use a depression screening tool (50% vs. 19%, p = .001), to have diagnosed at least one adolescent with depression in the past 3 months (96% vs. 78%, p = .013), and to have screened depressed adolescents for suicide risk factors, including access to weapons (51% vs. 25%; p = .007) or an impulsive violence history (27% vs. 11%; p = .037). PCP confidence and knowledge about depression assessment and treatment also significantly improved postintervention.


CONCLUSIONS
This study supports the use of an SP intervention to improve PCP ADSRA confidence, knowledge, and practices. Widespread implementation of similar educational efforts has the potential to dramatically improve adolescent morbidity and mortality.
Division of Psychology and Psychiatry, Nemours Children's Clinic, Jacksonville, FL 32207, USA. efallucc@nemours.org
Elise M
EM
Fallucco
Mary K
MK
Conlon
Gregory
G
Gale
John N
JN
Constantino
Anne L
AL
Glowinski
D000293:Adolescent; D016497:Adolescent Health Services / Q000592:standards; D002983:Clinical Competence; D003863:Depression / Q000175:diagnosis* / Q000523:psychology; D005260:Female; D006801:Humans; D008297:Male; D011320:Primary Health Care / Q000592:standards*; D018570:Risk Assessment / Q000379:methods*; D013405:Suicide / Q000523:psychology / Q000706:statistics & numerical data*; D000092864:Suicide Prevention