title: Testing the feasibility of therapeutic identification of depression in young people in British general practice.
abstract: OBJECTIVE
  Depression in young people attending primary care is common and is associated with impairment and recurrence into adulthood. However, it remains under-recognized. This study evaluated the feasibility of training primary care practitioners (PCPs) in screening and therapeutic identification of adolescent depression, and assessed its effects on practitioner knowledge, attitudes, screening, and management.
  
  
  METHODS
  We trained PCPs in therapeutic identification of adolescent depression during general practice consultations. To assess changes in knowledge and attitudes, PCPs completed questionnaires before and after training. We ascertained changes in depression screening and identification rates in the 16 weeks before and after training from electronic medical records of young people aged 13-17 years. Post-training management of depression was recorded on a checklist.
  
  
  RESULTS
  Aspects of practitioner knowledge (of depression prevalence and treatment guidelines) and confidence (regarding depression identification and management) increased significantly (all p < .04). Overall screening rates were enhanced from .7% to 20% after the intervention and depression identification rates from .5% before training to 2% thereafter (29-fold and fourfold increases, respectively). Identification was significantly associated with PCP knowledge of prior mental health problems (Fisher's exact test, p = .026; odds ratio, 4.884 [95% confidence interval, 1.171-20.52]) and of psychosocial stressors (Fisher's exact test, p = .001; odds ratio, 17.45 [95% confidence interval, 2.055-148.2]).
  
  
  CONCLUSIONS
  The Therapeutic Identification of Depression in Young People program is a feasible approach to improving primary care screening for adolescent depression, with promising evidence of effectiveness. Further evaluation in a randomized trial is required to test practitioner accuracy, clinical impact, and cost benefit.
authors.affiliation: Academic Unit of Child and Adolescent Psychiatry, Imperial College London, London, United Kingdom. t.kramer@imperial.ac.uk
authors.forename: Tami
authors.initials: T
authors.lastname: Kramer
authors.forename: Steve
authors.initials: S
authors.lastname: Iliffe
authors.forename: Amanda
authors.initials: A
authors.lastname: Bye
authors.forename: Lisa
authors.initials: L
authors.lastname: Miller
authors.forename: Julia
authors.initials: J
authors.lastname: Gledhill
authors.forename: M Elena
authors.initials: ME
authors.lastname: Garralda
mesh_terms: D000293:Adolescent; D057189:Checklist; D016001:Confidence Intervals; D003863:Depression / Q000175:diagnosis* / Q000453:epidemiology; D004739:England / Q000453:epidemiology; D005194:Family Practice / Q000193:education*; D005240:Feasibility Studies; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007318:Inservice Training; D008297:Male; D017410:Practice Guidelines as Topic; D015995:Prevalence; D011795:Surveys and Questionnaires