Adolescent mental health: A guide for the primary care provider (original) (raw)
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Identifying and treating adolescent mental health problems in primary health care
The period from late adolescence to the mid twenties, known as transition to grown up age, is a risk period for development depression. Stomach pain, headache and fatigue are common symptoms in children and adolescents suffering from depression. Patients often fail to mention their emotional problems during the family physician's consultation. Together with the physician's insufficient ability to recognize the hidden part in the physician-patient relationship, it makes early diagnosis and adequate intervention more difficult. Aim: To enlighten the role of a well-educated family physician as a coordinator in team work and shared medical care in identifying and treating adolescent mental health problems. Method: Family physician's bio-psychosocial approach. Results: Case report of an adolescent girl who developed depression connected to multiple family environment problems is presented. Problems connected to depression started five years ago. They appeared as somatic troub...
Adolescent Depression: Identification and Treatment
Current treatment options in pediatrics, 2018
Purpose of review Adolescent depression is a prevalent condition that has been on the rise in recent years. The primary care setting is often the front line to mental health needs, specifically identifying and treating early depression. This review presents the current evidence base about adolescent depression, its identification, and treatment approaches. Recent findings The US Preventive Services Task Force and American Academy of Pediatrics recommend universal screening for depression in adolescents in primary care settings. There are several depression screening measures that could be useful in primary care. Recommended treatment approaches which include therapy, medication, or a combination of the two are based on an adolescent's presentation and degree of impairment. There is sufficient empirical evidence supporting use of three therapies and two Selective Serotonin Reuptake Inhibitors for adolescent depression. Summary Currently, there are resources, screening measures, and research evidence available to adequately support pediatricians in the identification and treatment of adolescent depression.
Expert Survey for the Management of Adolescent Depression in Primary Care
2010
OBJECTIVE. Primary care clinics have become the "de facto" mental health clinics for teens with mental health problems such as depression; however, there is little guidance for primary care professionals who are faced with treating this population. This study surveyed experts on key management issues regarding adolescent depression in primary care where empirical literature was scant or absent.
Pediatric Emergency Care, 2010
Objective: Pediatric emergency department (PED) providers are strategically positioned to identify adolescents with depression. Our objectives were to describe health care providers' perspectives on adolescent depression and the role of depression screening in the PED. Methods: We conducted semistructured interviews with 41 health care providers from an urban, academic PED (including PED attending physicians and trainees, social workers, and psychiatrists). Interviews were audiotaped, transcribed, and entered into the N6 qualitative data analysis software version 6 (QSR International Pty Ltd, Cambridge, Mass) for coding and analysis. A multidisciplinary team used content analysis to identify 2 primary domains: (1) provider attitudes about adolescent depression and (2) factors associated with adolescent depression screening processes in a PED setting. Results: The PED-based providers demonstrated a clear understanding of the clinical burden of adolescent depression but described complex individual and system-level barriers to addressing the issue. All providers recognized the high prevalence of adolescent depression and its impact on health and described adolescent depression as a moderateto-large problem that was greatly underrecognized but applied primarily a biomedical model for treatment options. The respondents endorsed computerized screening as a useful approach. Concerns were raised universally regarding the ability of the health care system to respond to screened adolescents found to be depressed. Conclusions: The study describes the perspectives of multiple, key stakeholders necessary for a system response to the identification, assessment, and management of adolescent depression in the PED. The PED providers were generally supportive of computerized depression screening in the PED setting but also voiced the need for system-level responses that facilitate access to quality mental health care services for adolescents.
Depressive symptoms in adolescence: the association with multiple health risk behaviors
General Hospital Psychiatry, 2010
Recent epidemiologic studies have found that most patients with mental illness are seen exclusively in primary care medicine. These patients often present with medically unexplained somatic symptoms and utilize at least twice as many health care visits as controls. There has been an exponential growth in studies in this interface between primary care and psychiatry in the last 10 years. This special section, edited by Jürgen Unutzer, M.D., will publish informative research articles that address primary care-psychiatric issues.
Trends in mental health of an adolescent medicine clinic patient population
International journal of adolescent medicine and health
The correlation between exposure to forms of violence and development of mental disorders in victims is well established. The purpose of this paper was to identify mental health problems in an adolescent medicine clinic population in Lexington, KY and to investigate potential correlation of mental disorders with psychosocial factors. Data were gathered from the charts of 169 adolescent clinic patients (age 10-22) seen in the clinic for mental health care and analyzed using Excel. Of the patient population, 68% were urban, whereas 32% were rural. In terms of gender, 40% of the patients were male and 60% were female, 80% were white, 13% black, and 7% had other racial background(s). The most prevalent mental disorders in this group were depression 32.12%, 13% with generalized anxiety disorder, 8.2% with an attention deficit disorder (including ADHD), and 5.76% with an adjustment disorder. The abovementioned demographic trends showed that depression continues to be the most common menta...
Screening and managing depression in adolescents
Adolescent Health, Medicine and Therapeutics, 2010
Approximately 10%-15% of adolescents will experience a major depressive episode. The risk factors associated with depression in adolescence include a family history of depression, being female, subthreshold depression, having a nonaffective disorder, negative cognitions, interpersonal conflict, low social support, and stressful life events. Despite the availability of measures to identify depressed adolescents and efficacious interventions to treat these adolescents, a large number of depressed adolescents go undetected and untreated. This review describes several screening measures that can be used to identify adolescents with elevated depression symptoms who would benefit from a comprehensive diagnostic evaluation. If an adolescent is diagnosed with a depressive disorder, there are several efficacious treatment options, including pharmacotherapy, cognitive behavior therapy, and interpersonal psychotherapy. The research supporting each of these approaches is outlined, and recommendations are made to help health professionals determine the appropriate course of treatment. Although existing treatments are effective for many depressed adolescents, approximately one-third of adolescents remain depressed following treatment. Continuing research is needed to enhance the efficacy of existing treatments for adolescent depression and to develop and study novel treatment approaches.
Characteristics of Anxious and Depressed Youth Seen in Two Different Clinical Contexts
Administration and Policy in Mental Health and Mental Health Services Research, 2011
Previous research has revealed that youth seen at community clinics present with a higher frequency of externalizing problems and are demographically different from youth seen at research clinics. This study extends findings on these discrepancies by examining differences between youth at research and community clinics meeting criteria for two different primary disorders (anxiety and depression). Consistent with prior research, community clinic youth reported lower incomes, were more ethnically diverse, and had higher rates of externalizing problems compared to research clinic youth, regardless of primary diagnosis. Findings are discussed in terms of enhancing dissemination of evidence-based treatments for internalizing disorders in community settings.
Usual Care for Adolescent Depression From Symptom Identification Through Treatment Initiation
JAMA Pediatrics, 2016
IMPORTANCE Published guidelines describing effective adolescent depression care in primary care settings include screening, assessment, treatment initiation, and symptom monitoring. It is unclear the extent to which these steps are documented in patient health records. OBJECTIVE To determine rates of appropriate follow-up care for adolescents with newly identified depression symptoms in 3 large health systems. DESIGN, SETTING, AND PARTICIPANTS In this analysis conducted from March to September 2014, structured data retrospectively extracted from electronic health records were analyzed for 3 months following initial symptom identification to determine whether the patient was followed up and, if so, whether treatment was initiated and/or symptoms were monitored. Records were collected from 2 large health maintenance organizations in the western United States and a network of community health centers in the Northeast. The study group included adolescents (N = 4612) with newly identified depression symptoms, defined as an elevated score on the Patient Health Questionnaire (Ն10) and/or a diagnosis of depression. MAIN OUTCOMES AND MEASURES Rates of treatment initiation, symptom monitoring, and follow-up care documented within 3 months of initial symptom identification. RESULTS Among the 4612 participants, the mean (SD) age at index event was 16.0 (2.3) years, and 3060 were female (66%). Treatment was initiated for nearly two-thirds of adolescents (79% of those with a diagnosis of major depression; n = 1023); most received psychotherapy alone or in combination with medications. However, in the 3 months following identification, 36% of adolescents received no treatment (n = 1678), 68% did not have a follow-up symptom assessment (n = 3136), and 19% did not receive any follow-up care (n = 854). Further, 40% of adolescents prescribed antidepressant medication did not have any documentation of follow-up care for 3 months (n = 356). Younger age