PEDIATRICS Vol. 120 No. 5 November 2007, pp. e1299-e1312 (doi:10.1542/peds.2007-1144)
SPECIAL ARTICLE |
Guidelines for Adolescent Depression in Primary Care (GLAD-PC): I. Identification, Assessment, and Initial Management
a Division of Child Psychiatry, Department of Psychiatry, Columbia University/New York State Psychiatric Institute, New York, New York
b Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
c REACH Institute, Resource for Advancing Children's Health, New York, New York
d Department of Pediatrics, Albert Einstein College of Medicine, Bronx, New York
e Department of Pediatrics, Mount Sinai School of Medicine, New York, New York
OBJECTIVES. To develop clinical practice guidelines to assist primary care clinicians in the management of adolescent depression. This first part of the guidelines addresses identification, assessment, and initial management of adolescent depression in primary care settings.
METHODS. By using a combination of evidence- and consensus-based methodologies, guidelines were developed by an expert steering committee in 5 phases, as informed by (1) current scientific evidence (published and unpublished), (2) a series of focus groups, (3) a formal survey, (4) an expert consensus workshop, and (5) draft revision and iteration among members of the steering committee.
RESULTS. Guidelines were developed for youth aged 10 to 21 years and correspond to initial phases of adolescent depression management in primary care, including identification of at-risk youth, assessment and diagnosis, and initial management. The strength of each recommendation and its evidence base are summarized. The identification, assessment, and initial management section of the guidelines includes recommendations for (1) identification of depression in youth at high risk, (2) systematic assessment procedures using reliable depression scales, patient and caregiver interviews, and Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition criteria, (3) patient and family psychoeducation, (4) establishing relevant links in the community, and (5) the establishment of a safety plan.
CONCLUSIONS. This part of the guidelines is intended to assist primary care clinicians in the identification and initial management of depressed adolescents in an era of great clinical need and a shortage of mental health specialists but cannot replace clinical judgment; these guidelines are not meant to be the sole source of guidance for adolescent depression management. Additional research that addresses the identification and initial management of depressed youth in primary care is needed, including empirical testing of these guidelines.
Key Words: depression • primary care • guidelines
Abbreviations: PC—primary care • RCT—randomized, controlled, clinical trial • GLAD-PC—Guidelines for the Management of Adolescent Depression in Primary Care • MDD—major depressive disorder • DSM-IV—Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition
Accepted Apr 16, 2007.
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