Published online August 1, 2006
PEDIATRICS Vol. 118 No. 2 August 2006, pp. 669-682 (doi:10.1542/peds.2005-2086)
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ARTICLE

Interventions for Adolescent Depression in Primary Care

Ruth E.K. Stein, MDa, Lauren E. Zitner, BAb and Peter S. Jensen, MDb

a Department of Pediatrics, Albert Einstein College of Medicine/Children's Hospital at Montefiore, New York, New York
b Center for the Advancement of Children's Mental Health, Division of Child and Adolescent Psychiatry, Department of Psychiatry, Columbia University/New York State Psychiatric Institute, New York, New York

BACKGROUND. Depression in adolescents is underrecognized and undertreated despite its poor long-term outcomes, including risk for suicide. Primary care settings may be critical venues for the identification of depression, but there is little information about the usefulness of primary care interventions.

OBJECTIVE. We sought to examine the evidence for the treatment of depression in primary care settings, focusing on evidence concerning psychosocial, educational, and/or supportive intervention strategies.

METHODS. Available data on brief psychosocial treatments for adolescent depression in primary settings were reviewed. Given the paucity of direct studies, we also drew on related literature to summarize available evidence whether brief, psychosocial support from a member of the primary care team, with or without medication, might improve depression outcomes.

RESULTS. We identified 37 studies relevant to treating adolescent depression in primary care settings. Only 4 studies directly examined the impact of primary care–delivered psychosocial interventions for adolescent depression, but they suggest that such interventions can be effective. Indirect evidence from other psychosocial/behavioral interventions, including anticipatory guidance and efforts to enhance treatment adherence, and adult depression studies also show benefits of primary care–delivered interventions as well as the impact of provider training to enhance psychosocial skills.

CONCLUSIONS. There is potential for successful treatment of adolescent depression in primary care, in view of evidence that brief, psychosocial support, with or without medication, has been shown to improve a range of outcomes, including adolescent depression itself. Given the great public health problem posed by adolescent depression, the likelihood that most depressed adolescents will not receive specialty services, and new guidelines for managing adolescent depression in primary care, clinicians may usefully consider initiation of supportive interventions in their primary care practices.

Key Words: adolescent depression • primary care • treatment • psychosocial intervention

Abbreviations: PCC—primary care clinician • IPT-A—interpersonal therapy modified for depressed adolescents • CES-D—Center for Epidemiologic Studies-Depression Scale • QI—quality improvement • CBT—cognitive behavioral therapy • SSRI—selective serotonin reuptake inhibitor • ADHD—attention-deficit/hyperactivity disorder • CST—coping skills training

Accepted Mar 2, 2006.




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