Effectiveness of a Quality Improvement Intervention for Adolescent Depression in Primary Care Clinics

Abstract

15% to 20%, 1 current prevalence is estimated as high as 6%, 2 and 28.3% of adolescents report periods during the past year of depressive symptoms leading to impairment. 3 Untreated depression is associated with suicide, a leading cause of death for youth aged 15 to 24 years, 4,5 and with other negative outcomes including school dropout, pregnancy, substance abuse, and adult depression. 2,[5][6][7][8][9] The treatment literature supports efficacy for cognitive-behavior therapy (CBT), 10-14 interpersonal psychotherapy, [14][15][16] and some selective serotonin reuptake inhibitors, [17][18][19][20][21] with recent data indicating an advantage of combined CBT and medication for the treatment of adolescent major depression. 21 Practice parameters have been developed and algorithms tested to guide pharmacotherapy. [22][23][24] However, due to uncertainty regarding the safety and efficacy of selective seroto-Author Affiliations and Financial Disclosures are listed at the end of this article.

Adolescents' relationships with their mothers and fathers: Associations with depressive disorder and subdiagnostic symptomatology.

“…It has a well-established record of use as a screener for depressive symptomatology in adolescent samples (e.g., Asarnow, Jaycox, Duan, LaBorde, Rea, Murray, et al, 2005;Dierker, Albano, Clarke, Heimberg, Kendall, Merikangas, et al, 2001;Roberts, Lewinsohn, & Seeley, 1991). As described above the CES-D was used as the initial gate of a two-stage recruitment and screening procedure.…”

Evidence for the Management of Adolescent Depression

“…107 There are no systematic reviews or metaanalyses evaluating provider communication per se, but care coordination interventions requiring interprovider communication have led to positive outcomes in pediatric and child mental health settings. 8,108,109 Adult collaborative care intervention studies, including meta-analyses, provide similar evidence. 110,111 Practice Implications…”

“…6 Adolescent depression is associated with negative academic, social, and health outcomes, including depression in adulthood, substance abuse, early pregnancy and parenthood, higher medical expenses, and increased suicide risk. 2,[7][8][9][10][11][12][13][14][15] Despite the high burden of depression and the availability of effective treatments, up to 80% of affected adolescents do not receive appropriate care. 2,[16][17][18][19] The challenging task of identifying adolescents with depression falls disproportionately to pediatricians, as most depressed adolescents present in primary rather than specialty care.…”

Sensitization and its impact on Reproductive and sexual health issues of adolescents in clinics and schools - a comparative study.

“…[6][7][8] One of these studies 6 , in which young people were invited to attend a nurse-led general-practice visit reported only minor changes in participants' health-risk behaviours. The other studies, which focused on reductions in sexual-risk behaviours, reported a positive effect of the intervention.…”

“…The other studies, which focused on reductions in sexual-risk behaviours, reported a positive effect of the intervention. 7,8 In a study, information and education activities of health workers in health facilities were considered key contributors to the changes in reported behaviors of the adolescents. 9 Most studies suggest that access to all settings can be improved through youth-friendly interventions.…”