Expert survey for the management of adolescent depression in primary care

Amy H. Cheung, Rachel A. Zuckerbrot, Peter S. Jensen, Ruth E K Stein, Danielle Laraque, Boris Birmaher, John Campo, Greg Clarke, Dave Davis, Angela Diaz, Allen Dietrich, Graham Emslie, Bernard Ewigman, Eric Fombonne, Sharon Glied, Kimberly Eaton Hoagwood, Charles Homer, Miriam Kaufman, Kelly J. Kelleher, Stanley Kutcher & 6 others Michael Malus, James Perrin, Harold Pincus, Brenda Reiss-Brennan, Diane Sacks, Bruce Waslick

Research output: Contribution to journalArticle

Abstract

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. METHODS. Participants included experts from family medicine, pediatrics, nursing, psychology, and child psychiatry, identified through nonprobability sampling. The expert survey was developed on the basis of information from focus groups with patients, families, and professionals and from the research literature and included sections on early identification, assessment and diagnosis, initial management, treatment, and ongoing management. Means, standard deviations, and confidence intervals were calculated for each survey item. RESULTS. Seventy-eight of 81 experts agreed to participate (return rate of 96%). Fifty-three percent of the experts (n = 40) were primary care professionals. Experts endorsed routine surveillance for youth at high risk for depression, as well as the use of standardized measures as diagnostic aids. For treatment, "active monitoring" was deemed appropriate in mild depression with recent onset. Medication and psychotherapy were considered acceptable options for treatment of moderate depression without complicating factors such as comorbid illness. Fluoxetine was rated as the most appropriate antidepressant for use in this population. Finally, experts agreed that patients who are started on antidepressants should be followed within 2 weeks after initiation. CONCLUSIONS. Survey results support the identification and management of adolescent depression in the primary care setting and, in specific situations, referral and co-management with specialty mental health professionals. Even with the recent controversies around treatment, experts across primary care and specialty mental health alike agreed that active monitoring, pharmacotherapy with selective serotonin reuptake inhibitors, and psychotherapy can be appropriate under certain clinical circumstances when initiated within primary care settings.

Original languageEnglish (US)
JournalPediatrics
Volume121
Issue number1
DOIs
StatePublished - Jan 2008

Fingerprint

Primary Health Care
Depression
Mental Health
Psychotherapy
Antidepressive Agents
Pediatric Nursing
Child Psychology
Child Psychiatry
Fluoxetine
Serotonin Uptake Inhibitors
Therapeutics
Surveys and Questionnaires
Focus Groups
Population
Referral and Consultation
Medicine
Confidence Intervals
Drug Therapy

Keywords

  • Adolescents
  • Depression
  • Expert survey
  • Primary care

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

Cite this

Cheung, A. H., Zuckerbrot, R. A., Jensen, P. S., Stein, R. E. K., Laraque, D., Birmaher, B., ... Waslick, B. (2008). Expert survey for the management of adolescent depression in primary care. Pediatrics, 121(1). https://doi.org/10.1542/peds.2006-3560

Expert survey for the management of adolescent depression in primary care. / Cheung, Amy H.; Zuckerbrot, Rachel A.; Jensen, Peter S.; Stein, Ruth E K; Laraque, Danielle; Birmaher, Boris; Campo, John; Clarke, Greg; Davis, Dave; Diaz, Angela; Dietrich, Allen; Emslie, Graham; Ewigman, Bernard; Fombonne, Eric; Glied, Sharon; Hoagwood, Kimberly Eaton; Homer, Charles; Kaufman, Miriam; Kelleher, Kelly J.; Kutcher, Stanley; Malus, Michael; Perrin, James; Pincus, Harold; Reiss-Brennan, Brenda; Sacks, Diane; Waslick, Bruce.

In: Pediatrics, Vol. 121, No. 1, 01.2008.

Research output: Contribution to journalArticle

Cheung, AH, Zuckerbrot, RA, Jensen, PS, Stein, REK, Laraque, D, Birmaher, B, Campo, J, Clarke, G, Davis, D, Diaz, A, Dietrich, A, Emslie, G, Ewigman, B, Fombonne, E, Glied, S, Hoagwood, KE, Homer, C, Kaufman, M, Kelleher, KJ, Kutcher, S, Malus, M, Perrin, J, Pincus, H, Reiss-Brennan, B, Sacks, D & Waslick, B 2008, 'Expert survey for the management of adolescent depression in primary care', Pediatrics, vol. 121, no. 1. https://doi.org/10.1542/peds.2006-3560
Cheung AH, Zuckerbrot RA, Jensen PS, Stein REK, Laraque D, Birmaher B et al. Expert survey for the management of adolescent depression in primary care. Pediatrics. 2008 Jan;121(1). https://doi.org/10.1542/peds.2006-3560
Cheung, Amy H. ; Zuckerbrot, Rachel A. ; Jensen, Peter S. ; Stein, Ruth E K ; Laraque, Danielle ; Birmaher, Boris ; Campo, John ; Clarke, Greg ; Davis, Dave ; Diaz, Angela ; Dietrich, Allen ; Emslie, Graham ; Ewigman, Bernard ; Fombonne, Eric ; Glied, Sharon ; Hoagwood, Kimberly Eaton ; Homer, Charles ; Kaufman, Miriam ; Kelleher, Kelly J. ; Kutcher, Stanley ; Malus, Michael ; Perrin, James ; Pincus, Harold ; Reiss-Brennan, Brenda ; Sacks, Diane ; Waslick, Bruce. / Expert survey for the management of adolescent depression in primary care. In: Pediatrics. 2008 ; Vol. 121, No. 1.
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AU - Cheung, Amy H.

AU - Zuckerbrot, Rachel A.

AU - Jensen, Peter S.

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AU - Laraque, Danielle

AU - Birmaher, Boris

AU - Campo, John

AU - Clarke, Greg

AU - Davis, Dave

AU - Diaz, Angela

AU - Dietrich, Allen

AU - Emslie, Graham

AU - Ewigman, Bernard

AU - Fombonne, Eric

AU - Glied, Sharon

AU - Hoagwood, Kimberly Eaton

AU - Homer, Charles

AU - Kaufman, Miriam

AU - Kelleher, Kelly J.

AU - Kutcher, Stanley

AU - Malus, Michael

AU - Perrin, James

AU - Pincus, Harold

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N2 - 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. METHODS. Participants included experts from family medicine, pediatrics, nursing, psychology, and child psychiatry, identified through nonprobability sampling. The expert survey was developed on the basis of information from focus groups with patients, families, and professionals and from the research literature and included sections on early identification, assessment and diagnosis, initial management, treatment, and ongoing management. Means, standard deviations, and confidence intervals were calculated for each survey item. RESULTS. Seventy-eight of 81 experts agreed to participate (return rate of 96%). Fifty-three percent of the experts (n = 40) were primary care professionals. Experts endorsed routine surveillance for youth at high risk for depression, as well as the use of standardized measures as diagnostic aids. For treatment, "active monitoring" was deemed appropriate in mild depression with recent onset. Medication and psychotherapy were considered acceptable options for treatment of moderate depression without complicating factors such as comorbid illness. Fluoxetine was rated as the most appropriate antidepressant for use in this population. Finally, experts agreed that patients who are started on antidepressants should be followed within 2 weeks after initiation. CONCLUSIONS. Survey results support the identification and management of adolescent depression in the primary care setting and, in specific situations, referral and co-management with specialty mental health professionals. Even with the recent controversies around treatment, experts across primary care and specialty mental health alike agreed that active monitoring, pharmacotherapy with selective serotonin reuptake inhibitors, and psychotherapy can be appropriate under certain clinical circumstances when initiated within primary care settings.

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