title: Primary care provider training in screening, assessment, and treatment of adolescent depression.
abstract: OBJECTIVE
  Adolescent depression is underrecognized and undertreated. Primary care providers (PCP) require training to successfully identify adolescents with depression. We examined the effects of a PCP training program in the screening, assessment, and treatment of adolescent depression (SAT-D) on adolescents' reports of PCP screening for adolescent depression at annual well visits and PCP SAT-D confidence and knowledge.
  
  
  METHODS
  PCP (n = 31) attended one SAT-D training program consisting of a 60-minute SAT-D seminar and a 60-minute standardized patient session where PCP practiced SAT-D skills. A pre-post design evaluated effects of training on PCP depression screening practices as reported by 3 groups of adolescent patients at well visits (n = 582 before, n = 525 at 2 to 8 months after training, n = 208 at 18 to 24 months after training). A generalized linear mixed effects logistic regression controlled for provider and patient demographics that may have influenced depression screening. PCP SAT-D self-reported confidence and objectively tested knowledge were assessed at baseline, immediately after training, and at 4 to 6 months after training.
  
  
  RESULTS
  On the basis of the regression analysis, PCP screening for adolescent depression increased significantly from pretraining (49%) to 2 to 8 months after training (68%, odds ratio 2.78, 95% confidence interval 2.10-3.68) and 18 to 24 months after training (74%, odds ratio 3.17, 95% confidence interval 2.16-4.67; both P < .0001). PCP SAT-D confidence and knowledge also significantly improved.
  
  
  CONCLUSIONS
  PCP SAT-D training resulted in significant increases in primary care screening for adolescent depression that were maintained up to 24 months after training. Future studies should determine if changes in PCP screening improve identification of adolescent depression and patient outcomes for adolescents with depression.
authors.affiliation: Nemours Center for Health Care Delivery Science, University of Florida, Jacksonville, Fla; Division of Psychiatry and Psychology, Nemours Children's Clinic, University of Florida, Jacksonville, Fla. Electronic address: Elise.Fallucco@nemours.org.
authors.forename: Elise M
authors.initials: EM
authors.lastname: Fallucco
authors.affiliation: Nemours Center for Health Care Delivery Science, University of Florida, Jacksonville, Fla.
authors.forename: Robbin D
authors.initials: RD
authors.lastname: Seago
authors.affiliation: Department of Psychiatry, University of Florida, Jacksonville, Fla.
authors.forename: Steven P
authors.initials: SP
authors.lastname: Cuffe
authors.affiliation: Center for Health Equity and Quality Research and Department of Neurology, University of Florida, University of Florida, Jacksonville, Fla.
authors.forename: Dale F
authors.initials: DF
authors.lastname: Kraemer
authors.affiliation: Nemours Center for Health Care Delivery Science, University of Florida, Jacksonville, Fla.
authors.forename: Tim
authors.initials: T
authors.lastname: Wysocki
mesh_terms: D000293:Adolescent; D003863:Depression / Q000175:diagnosis*; D003866:Depressive Disorder / Q000175:diagnosis*; D005260:Female; D006801:Humans; D016014:Linear Models; D016015:Logistic Models; D008297:Male; D008403:Mass Screening / Q000706:statistics & numerical data*; D016017:Odds Ratio; D016544:Patient Simulation; D058007:Physicians, Primary Care / Q000193:education*; D011320:Primary Health Care; D000066908:Simulation Training
keywords: adolescent depression; primary care; screening; standardized patient