title: Parents' Role in Adolescent Depression Care: Primary Care Provider Perspectives.
abstract: OBJECTIVE
  To understand how primary care providers (PCPs) perceive barriers to adolescent depression care to inform strategies to increase treatment engagement.
  
  
  METHODS
  We conducted semistructured interviews with 15 PCPs recruited from community pediatric offices with access to integrated behavioral health services (ie, low system-level barriers to care) who participated in a larger study on treating adolescent depression. Interviews addressed PCP perceptions of barriers to adolescents' uptake of care for depression. Interviews were audiorecorded, transcribed, and coded for key themes.
  
  
  RESULTS
  Although PCPs mentioned several adolescent barriers to care, they thought parents played a critical role in assisting adolescents in accessing mental health services. Important aspects of the parental role in accessing treatment included transportation, financial support, and social support. PCPs perceived that parental unwillingness to accept the depression diagnosis, family dysfunction, and trauma were common barriers. PCPs contrasted this with examples of good family support they believed would enable adolescents to attend follow-up appointments and have a "life coach" at home to help monitor for side effects and watch for increased suicidality when starting antidepressants.
  
  
  CONCLUSIONS
  In this PCP population, which had enhanced access to mental health specialists, PCPs primarily reported attitudinal barriers to adolescent depression treatment, focusing mainly on perceived parent barriers. The results of these qualitative interviews provide a framework for understanding PCP perceptions of parental barriers to care, identifying that addressing complex parental barriers to care may be important for future interventions.
authors.affiliation: Children's Hospital of Pittsburgh of the University of Pittsburgh Medical Center, Pittsburgh, PA; Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA.
authors.forename: Ana
authors.initials: A
authors.lastname: Radovic
authors.affiliation: RAND Corporation, Pittsburgh, PA.
authors.forename: Kerry
authors.initials: K
authors.lastname: Reynolds
authors.affiliation: Children's Hospital of Pittsburgh of the University of Pittsburgh Medical Center, Pittsburgh, PA; Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA.
authors.forename: Heather L
authors.initials: HL
authors.lastname: McCauley
authors.affiliation: Children's Hospital of Pittsburgh of the University of Pittsburgh Medical Center, Pittsburgh, PA; Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA; Group Health, Seattle, WA.
authors.forename: Gina S
authors.initials: GS
authors.lastname: Sucato
authors.affiliation: RAND Corporation, Pittsburgh, PA; Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA.
authors.forename: Bradley D
authors.initials: BD
authors.lastname: Stein
authors.affiliation: Children's Hospital of Pittsburgh of the University of Pittsburgh Medical Center, Pittsburgh, PA; Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Miller
mesh_terms: D000293:Adolescent; D000295:Adolescent Medicine / Q000458:organization & administration; D000328:Adult; D001294:Attitude to Health; D015331:Cohort Studies; D003863:Depression / Q000523:psychology / Q000628:therapy*; D005192:Family Health; D005260:Female; D006297:Health Services Accessibility; D006801:Humans; D008297:Male; D008605:Mental Health Services / Q000458:organization & administration; D008875:Middle Aged; D010287:Parent-Child Relations; D010290:Parents; D010372:Pediatrics; D010465:Perception; D011320:Primary Health Care / Q000458:organization & administration*