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Eva Henje Blom - One of the best experts on this subject based on the ideXlab platform.
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feasibility and preliminary efficacy of a novel rdoc based treatment program for Adolescent Depression training for awareness resilience and action tara a pilot study
Frontiers in Psychiatry, 2017Co-Authors: Colm G Connolly, Eva Henje Blom, Larissa G Duncan, Margaret A Chesney, Olga Tymofiyeva, Patricia J Moran, Lisa Baldini, Helen Y WengAbstract:Background The novel group treatment program Training for Awareness, Resilience, and Action (TARA) was developed to target specific mechanisms based on neuroscience findings in Adolescent Depression and framed within the NIMH Research Domain Criteria (RDoC). TARA contains training of autonomic and emotional self-regulation, interoceptive awareness, relational skills and values-based committed action. Methods We performed a single-arm trial to test the feasibility and preliminary efficacy of TARA in reducing Depression and anxiety levels, and assessed whether the specific targeted domains of function reflected the hypothesized symptom change. Twenty-six Adolescents (14-18 years old, 7 males and 19 females) participated in the 12-week group program. Assessment was performed before (T0), immediately after (T1) and three months after the end of TARA (T2). Results Significant improvement was seen in Depression symptoms (Reynolds Adolescent Depression Scale, 2nd edition) between T0-T1 (t value = -3.56, p = 0.002, CI = (-6.64,-1.77)) and T0-T2 (t value= -4.17, p < 0.001, CI = -11.20, -3.75)) and anxiety symptoms (Multidimensional Anxiety Scale for Children) between T0-T1 (t value = -2.26, p = 0.033, CI=-4.61,-0.21) and T0-T2 (t value = -3.06, p = 0.006, CI95% (-9.02,-1.73). Significant improvements in psychological flexibility, sleep, and mindfulness skills were also found between T0-T2. Limitations The sample size was small without a control condition. The pilot design did not allow for testing the hypothesized brain changes, and effect of TARA on relevant systemic biomarkers. Conclusions TARA is feasible in a sample of clinically depressed and/or anxious Adolescents and preliminary efficacy was demonstrated by reduced Depression and anxiety symptoms. The specific symptom and behavioral outcomes corresponded well with the hypothesized mechanisms of change.
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the development of an rdoc based treatment program for Adolescent Depression training for awareness resilience and action tara
Frontiers in Human Neuroscience, 2014Co-Authors: Kaja Z Lewinn, Colm G Connolly, Eva Henje Blom, Larissa G Duncan, Margaret A Chesney, Frederick Hecht, Tony T YangAbstract:Major depressive disorder (MDD) is one of the current leading causes of disability worldwide. Adolescence is a vulnerable period for the onset of Depression, with MDD affecting 8-20% of all youth. Traditional treatment methods have not been sufficiently effective to slow the increasing prevalence of Adolescent Depression. We therefore propose a new model for the treatment of Adolescent Depression – Training for Awareness, Resilience, and Action (TARA) – that is based on current understanding of developmental and Depression neurobiology. The TARA model is aligned with the Research Domain Criteria (RDoC) of the National Institute of Mental Health. In this article, we first address the relevance of RDoC to Adolescent Depression. Second, we identify the major RDoC domains of function involved in Adolescent Depression and organize them in a way that gives priority to domains thought to be driving the psychopathology. Third, we select therapeutic training strategies for TARA based on current scientific evidence of efficacy for the prioritized domains of function in a manner that maximizes time, resources, and feasibility. The TARA model takes into consideration the developmental limitation in top-down cognitive control in adolescence and promotes bottom-up strategies such as vagal afference to decrease limbic hyperactivation and its secondary effects. The program has been informed by mindfulness-based therapy and yoga, as well as modern psychotherapeutic techniques. The treatment program is semi-manualized, progressive, and applied in a module-based approach designed for a group setting that is to be conducted one session per week for 12 weeks. We hope that this work may form the basis for a novel and more effective treatment strategy for Adolescent Depression, as well as broaden the discussion on how to address this challenge.
Rachel A Zuckerbrot - One of the best experts on this subject based on the ideXlab platform.
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guidelines for Adolescent Depression in primary care glad pc part i practice preparation identification assessment and initial management
Pediatrics, 2018Co-Authors: Rachel A Zuckerbrot, Amy Cheung, Ruth E K Stein, Peter S Jensen, Danielle LaraqueAbstract:OBJECTIVES: To update clinical practice guidelines to assist primary care (PC) clinicians in the management of Adolescent Depression. This part of the updated guidelines is used to address practice preparation, identification, assessment, and initial management of Adolescent Depression in PC settings. METHODS: By using a combination of evidence- and consensus-based methodologies, guidelines were developed by an expert steering committee in 2 phases as informed by (1) current scientific evidence (published and unpublished) and (2) draft revision and iteration among the steering committee, which included experts, clinicians, and youth and families with lived experience. RESULTS: Guidelines were updated for youth aged 10 to 21 years and correspond to initial phases of Adolescent Depression management in PC, including the identification of at-risk youth, assessment and diagnosis, and initial management. The strength of each recommendation and its evidence base are summarized. The practice preparation, identification, assessment, and initial management section of the guidelines include recommendations for (1) the preparation of the PC practice for improved care of Adolescents with Depression; (2) annual universal screening of youth 12 and over at health maintenance visits; (3) the identification of Depression in youth who are at high risk; (4) systematic assessment procedures by using reliable Depression scales, patient and caregiver interviews, and Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition criteria; (5) patient and family psychoeducation; (6) the establishment of relevant links in the community, and (7) the establishment of a safety plan. CONCLUSIONS: This part of the guidelines is intended to assist PC clinicians in the identification and initial management of Adolescents with Depression in an era of great clinical need and shortage of mental health specialists, but they cannot replace clinical judgment; these guidelines are not meant to be the sole source of guidance for Depression management in Adolescents. Additional research that addresses the identification and initial management of youth with Depression in PC is needed, including empirical testing of these guidelines.
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guidelines for Adolescent Depression in primary care glad pc i identification assessment and initial management
Pediatrics, 2007Co-Authors: Rachel A Zuckerbrot, Amy Cheung, Ruth E K Stein, Peter S Jensen, Danielle LaraqueAbstract: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.
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guidelines for Adolescent Depression in primary care glad pc ii treatment and ongoing management
Pediatrics, 2007Co-Authors: Amy Cheung, Danielle Laraque, Peter S Jensen, Rachel A Zuckerbrot, Kareem Ghalib, Ruth E K SteinAbstract:OBJECTIVES.To develop clinical practice guidelines to assist primary care clinicians in the management of Adolescent Depression. This second part of the guidelines addresses treatment and ongoing management of Adolescent Depression in the primary care setting. METHODS.Using a combination of evidence- and consensus-based methodologies, guidelines were developed 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) revision and iteration among members of the steering committee. RESULTS.These guidelines are targeted for youth aged 10 to 21 years and offer recommendations for the management of Adolescent Depression in primary care, including (1) active monitoring of mildly depressed youth, (2) details for the specific application of evidence-based medication and psychotherapeutic approaches in cases of moderate-to-severe Depression, (3) careful monitoring of adverse effects, (4) consultation and coordination of care with mental health specialists, (5) ongoing tracking of outcomes, and (6) specific steps to be taken in instances of partial or no improvement after an initial treatment has begun. The strength of each recommendation and its evidence base are summarized. CONCLUSIONS.These guidelines cannot replace clinical judgment, and they should not be the sole source of guidance for Adolescent Depression management. Nonetheless, the guidelines may assist primary care clinicians in the management of depressed Adolescents in an era of great clinical need and a shortage of mental health specialists. Additional research concerning the management of youth with Depression in primary care is needed, including the usability, feasibility, and sustainability of guidelines and determination of the extent to which the guidelines actually improve outcomes of youth with Depression.
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Adolescent Depression screening in primary care feasibility and acceptability
Pediatrics, 2007Co-Authors: Rachel A Zuckerbrot, Laura Maxon, Dana Pagar, Mark W Davies, Prudence Fisher, David Williamson ShafferAbstract:OBJECTIVE. Despite available Depression treatments, only one fourth to one third of depressed Adolescents are receiving care. The problem of underdiagnosis and underreferral might be redressed if assessment of suicidality and Depression became a more formal part of routine pediatric care. Our purpose for this study was to explore the feasibility and acceptability of implementing Adolescent Depression screening into clinical practice. METHODS. In this study we implemented a 2-stage Adolescent identification protocol, a first-stage pen-and-paper screen and a second-stage computerized assessment, into a busy primary care pediatric practice. Providers tracked the number of eligible patients screened at both health maintenance and urgent care visits and provided survey responses regarding the burden that screening placed on the practice and the effect on patient/parent-provider relationships. RESULTS. Seventy-nine percent of Adolescent patients presenting for health maintenance visits were screened, as were the majority of patients presenting for any type of visit. The average completion time for the paper screen was 4.6 minutes. Providers perceived parents and patients as expressing more satisfaction than dissatisfaction with the screening procedures and that the increased time burden could be handled. All providers wished to continue using the paper screen at the conclusion of the protocol. CONCLUSIONS. Instituting universal systematic Depression screening in a practice with a standardized screening instrument met with little resistance by patients and parents and was well perceived and accepted by providers.
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improving recognition of Adolescent Depression in primary care
JAMA Pediatrics, 2006Co-Authors: Rachel A Zuckerbrot, Peter S JensenAbstract:Objective To address the following questions: (1) What evidence (ie, psychometric data collected in pediatric primary care, patient outcome data) exists for the various methods used to identify Adolescent Depression in primary care? and (2) What identification practices are currently in use? Data Sources We systematically searched MEDLINE for English-language articles using specific search terms and examined relevant titles, abstracts, and articles. Study Selection We reviewed 1743 MEDLINE abstracts. Seventy-four articles were pulled for examination, with 30 articles meeting full criteria. Data Extraction Five studies had adequate psychometric data on various Adolescent Depression identification methods in primary care. Only 1 compared the diagnostic accuracy of physicians trained to ask Depression questions vs physicians trained in the use of a diagnostic aid. Six studies reported on current practice. Evidence regarding sensitivity, specificity, positive predictive value, and negative predictive value was sought for question 1. Frequency of screening was sought for question 2. Data Synthesis Review of these articles found that few health care professionals use systematic Depression identification methods, despite some growing evidence for their validity, feasibility, and possible efficacy. Conclusion Available evidence indicates that primary care professionals would improve their rates of Depression diagnosis through training, but even more so by using Adolescent symptom rating scales.
Peter S Jensen - One of the best experts on this subject based on the ideXlab platform.
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guidelines for Adolescent Depression in primary care glad pc part i practice preparation identification assessment and initial management
Pediatrics, 2018Co-Authors: Rachel A Zuckerbrot, Amy Cheung, Ruth E K Stein, Peter S Jensen, Danielle LaraqueAbstract:OBJECTIVES: To update clinical practice guidelines to assist primary care (PC) clinicians in the management of Adolescent Depression. This part of the updated guidelines is used to address practice preparation, identification, assessment, and initial management of Adolescent Depression in PC settings. METHODS: By using a combination of evidence- and consensus-based methodologies, guidelines were developed by an expert steering committee in 2 phases as informed by (1) current scientific evidence (published and unpublished) and (2) draft revision and iteration among the steering committee, which included experts, clinicians, and youth and families with lived experience. RESULTS: Guidelines were updated for youth aged 10 to 21 years and correspond to initial phases of Adolescent Depression management in PC, including the identification of at-risk youth, assessment and diagnosis, and initial management. The strength of each recommendation and its evidence base are summarized. The practice preparation, identification, assessment, and initial management section of the guidelines include recommendations for (1) the preparation of the PC practice for improved care of Adolescents with Depression; (2) annual universal screening of youth 12 and over at health maintenance visits; (3) the identification of Depression in youth who are at high risk; (4) systematic assessment procedures by using reliable Depression scales, patient and caregiver interviews, and Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition criteria; (5) patient and family psychoeducation; (6) the establishment of relevant links in the community, and (7) the establishment of a safety plan. CONCLUSIONS: This part of the guidelines is intended to assist PC clinicians in the identification and initial management of Adolescents with Depression in an era of great clinical need and shortage of mental health specialists, but they cannot replace clinical judgment; these guidelines are not meant to be the sole source of guidance for Depression management in Adolescents. Additional research that addresses the identification and initial management of youth with Depression in PC is needed, including empirical testing of these guidelines.
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guidelines for Adolescent Depression in primary care glad pc ii treatment and ongoing management
Pediatrics, 2007Co-Authors: Amy Cheung, Danielle Laraque, Peter S Jensen, Rachel A Zuckerbrot, Kareem Ghalib, Ruth E K SteinAbstract:OBJECTIVES.To develop clinical practice guidelines to assist primary care clinicians in the management of Adolescent Depression. This second part of the guidelines addresses treatment and ongoing management of Adolescent Depression in the primary care setting. METHODS.Using a combination of evidence- and consensus-based methodologies, guidelines were developed 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) revision and iteration among members of the steering committee. RESULTS.These guidelines are targeted for youth aged 10 to 21 years and offer recommendations for the management of Adolescent Depression in primary care, including (1) active monitoring of mildly depressed youth, (2) details for the specific application of evidence-based medication and psychotherapeutic approaches in cases of moderate-to-severe Depression, (3) careful monitoring of adverse effects, (4) consultation and coordination of care with mental health specialists, (5) ongoing tracking of outcomes, and (6) specific steps to be taken in instances of partial or no improvement after an initial treatment has begun. The strength of each recommendation and its evidence base are summarized. CONCLUSIONS.These guidelines cannot replace clinical judgment, and they should not be the sole source of guidance for Adolescent Depression management. Nonetheless, the guidelines may assist primary care clinicians in the management of depressed Adolescents in an era of great clinical need and a shortage of mental health specialists. Additional research concerning the management of youth with Depression in primary care is needed, including the usability, feasibility, and sustainability of guidelines and determination of the extent to which the guidelines actually improve outcomes of youth with Depression.
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guidelines for Adolescent Depression in primary care glad pc i identification assessment and initial management
Pediatrics, 2007Co-Authors: Rachel A Zuckerbrot, Amy Cheung, Ruth E K Stein, Peter S Jensen, Danielle LaraqueAbstract: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.
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interventions for Adolescent Depression in primary care
Pediatrics, 2006Co-Authors: Ruth E K Stein, Lauren Zitner, Peter S JensenAbstract: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.
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improving recognition of Adolescent Depression in primary care
JAMA Pediatrics, 2006Co-Authors: Rachel A Zuckerbrot, Peter S JensenAbstract:Objective To address the following questions: (1) What evidence (ie, psychometric data collected in pediatric primary care, patient outcome data) exists for the various methods used to identify Adolescent Depression in primary care? and (2) What identification practices are currently in use? Data Sources We systematically searched MEDLINE for English-language articles using specific search terms and examined relevant titles, abstracts, and articles. Study Selection We reviewed 1743 MEDLINE abstracts. Seventy-four articles were pulled for examination, with 30 articles meeting full criteria. Data Extraction Five studies had adequate psychometric data on various Adolescent Depression identification methods in primary care. Only 1 compared the diagnostic accuracy of physicians trained to ask Depression questions vs physicians trained in the use of a diagnostic aid. Six studies reported on current practice. Evidence regarding sensitivity, specificity, positive predictive value, and negative predictive value was sought for question 1. Frequency of screening was sought for question 2. Data Synthesis Review of these articles found that few health care professionals use systematic Depression identification methods, despite some growing evidence for their validity, feasibility, and possible efficacy. Conclusion Available evidence indicates that primary care professionals would improve their rates of Depression diagnosis through training, but even more so by using Adolescent symptom rating scales.
Jason M Fletcher - One of the best experts on this subject based on the ideXlab platform.
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Adolescent Depression and educational attainment results using sibling fixed effects
Health Economics, 2009Co-Authors: Jason M FletcherAbstract:This paper contributes to the literature on the relationship between Adolescent Depression and educational attainment in several ways. First, while cross-sectional data are normally used, this paper uses longitudinal data in order to defend against the potential of reverse causality. Second, this is the first paper in the literature to control for sibling-fixed effects in examining the relationship between Adolescent depressive symptoms and human capital accumulation. Importantly, this eliminates omitted factors such as family and neighborhood characteristics common to siblings that affect both depressive symptoms and educational attainments (e.g. neighborhood crime, and family resources). Third, this paper examines the effects of both an indicator and scale of depressive symptoms and finds important associations with these depressive symptoms and human capital accumulation. Though the results cannot be given a causal interpretation, the findings show a negative relationship between depressive symptoms and years of schooling. The relationship appears to be driven primarily through increasing the chances of dropping out but may have small impacts on the likelihood of college attendance (conditional on high school graduation). In particular, preferred estimates suggest that a standard deviation increase in depressive symptoms is associated with a 25-30% increase in the likelihood of dropping out.
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Adolescent Depression and educational attainment results using sibling fixed effects
Social Science Research Network, 2009Co-Authors: Jason M FletcherAbstract:This paper contributes to the literature on the relationship between Adolescent Depression and educational attainment in several ways. First, while cross sectional data are normally used to assess the importance of the relationship, this paper uses longitudinal data in order to defend against the potential of reverse causality. Second, this is the first paper in the literature to control for sibling fixed effects in examining the relationship between Adolescent depressive symptoms and human capital accumulation. Importantly, this eliminates omitted factors such as family and neighborhood characteristics common to siblings that affect both depressive symptoms and educational attainments (e.g. neighborhood crime, family resources). Third, this paper examines the effects of both an indicator and scale of depressive symptoms and finds important associations with these depressive symptoms and human capital accumulation. Though not always precisely estimated, the results suggest that depressive symptoms decrease years of schooling, mainly through increasing the chances of dropping out but may have small impacts on the likelihood of college attendance (conditional on high school graduation). In particular, preferred estimates suggest that a standard deviation increase in depressive symptoms is associated with a 25-30% increase in the likelihood of dropping out.
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Adolescent Depression diagnosis treatment and educational attainment
Health Economics, 2008Co-Authors: Jason M FletcherAbstract:In this paper, I use nationally representative longitudinal data to examine Adolescent Depression and educational attainment. First, I examine the individual, family, and community-level determinants of Adolescent Depression, diagnosis, and treatment. I find that male and minority Adolescents who score high on Depression scales are less likely to be diagnosed as depressed or receive treatment than female and non-Hispanic white Adolescents. Additionally, I find several community-level variables to be important determinants of Depression, diagnosis, and treatment. Second, I examine the importance of Adolescent Depression for educational attainment. Although it is uncontroversial to expect a negative relationship, most previous research uses cross-sectional data, making it difficult to adequately determine the magnitude of the effect. I find that depressive symptoms are related to educational attainment along multiple margins: dropping out of high school, college enrollment, and college type. These relationships are only found for Adolescent females, and there are several interesting results across income groups. Overall, these findings suggest that further attempts to diagnose and treat Adolescents with depressive symptoms are needed and that additional treatment options may be required to combat the important relationship between Adolescent Depression and human capital accumulation for females.
Danielle Laraque - One of the best experts on this subject based on the ideXlab platform.
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guidelines for Adolescent Depression in primary care glad pc part i practice preparation identification assessment and initial management
Pediatrics, 2018Co-Authors: Rachel A Zuckerbrot, Amy Cheung, Ruth E K Stein, Peter S Jensen, Danielle LaraqueAbstract:OBJECTIVES: To update clinical practice guidelines to assist primary care (PC) clinicians in the management of Adolescent Depression. This part of the updated guidelines is used to address practice preparation, identification, assessment, and initial management of Adolescent Depression in PC settings. METHODS: By using a combination of evidence- and consensus-based methodologies, guidelines were developed by an expert steering committee in 2 phases as informed by (1) current scientific evidence (published and unpublished) and (2) draft revision and iteration among the steering committee, which included experts, clinicians, and youth and families with lived experience. RESULTS: Guidelines were updated for youth aged 10 to 21 years and correspond to initial phases of Adolescent Depression management in PC, including the identification of at-risk youth, assessment and diagnosis, and initial management. The strength of each recommendation and its evidence base are summarized. The practice preparation, identification, assessment, and initial management section of the guidelines include recommendations for (1) the preparation of the PC practice for improved care of Adolescents with Depression; (2) annual universal screening of youth 12 and over at health maintenance visits; (3) the identification of Depression in youth who are at high risk; (4) systematic assessment procedures by using reliable Depression scales, patient and caregiver interviews, and Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition criteria; (5) patient and family psychoeducation; (6) the establishment of relevant links in the community, and (7) the establishment of a safety plan. CONCLUSIONS: This part of the guidelines is intended to assist PC clinicians in the identification and initial management of Adolescents with Depression in an era of great clinical need and shortage of mental health specialists, but they cannot replace clinical judgment; these guidelines are not meant to be the sole source of guidance for Depression management in Adolescents. Additional research that addresses the identification and initial management of youth with Depression in PC is needed, including empirical testing of these guidelines.
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expert survey for the management of Adolescent Depression in primary care
Pediatrics, 2008Co-Authors: Amy Cheung, Rachel A Zuckerbro, Pete S Jense, Ruth E K Stei, Danielle Laraque, Oris Irmahe, Joh V Campo, Greg Clarke, Dave DavisAbstract: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. Language: en
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guidelines for Adolescent Depression in primary care glad pc ii treatment and ongoing management
Pediatrics, 2007Co-Authors: Amy Cheung, Danielle Laraque, Peter S Jensen, Rachel A Zuckerbrot, Kareem Ghalib, Ruth E K SteinAbstract:OBJECTIVES.To develop clinical practice guidelines to assist primary care clinicians in the management of Adolescent Depression. This second part of the guidelines addresses treatment and ongoing management of Adolescent Depression in the primary care setting. METHODS.Using a combination of evidence- and consensus-based methodologies, guidelines were developed 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) revision and iteration among members of the steering committee. RESULTS.These guidelines are targeted for youth aged 10 to 21 years and offer recommendations for the management of Adolescent Depression in primary care, including (1) active monitoring of mildly depressed youth, (2) details for the specific application of evidence-based medication and psychotherapeutic approaches in cases of moderate-to-severe Depression, (3) careful monitoring of adverse effects, (4) consultation and coordination of care with mental health specialists, (5) ongoing tracking of outcomes, and (6) specific steps to be taken in instances of partial or no improvement after an initial treatment has begun. The strength of each recommendation and its evidence base are summarized. CONCLUSIONS.These guidelines cannot replace clinical judgment, and they should not be the sole source of guidance for Adolescent Depression management. Nonetheless, the guidelines may assist primary care clinicians in the management of depressed Adolescents in an era of great clinical need and a shortage of mental health specialists. Additional research concerning the management of youth with Depression in primary care is needed, including the usability, feasibility, and sustainability of guidelines and determination of the extent to which the guidelines actually improve outcomes of youth with Depression.
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guidelines for Adolescent Depression in primary care glad pc i identification assessment and initial management
Pediatrics, 2007Co-Authors: Rachel A Zuckerbrot, Amy Cheung, Ruth E K Stein, Peter S Jensen, Danielle LaraqueAbstract: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.