“Adolescent depression is a serious and undertreated public health problem,” said Dr. Ana Radovic of Children’s Hospital of Pittsburgh of the University of Pittsburgh Medical Center.
“With the national shortage of child psychiatrists, education interventions which take into account a primary care provider’s feelings of burden when addressing mental health problems and collaborative care with mental health professionals will be needed to increase appropriate prescribing of antidepressant medications to depressed adolescents.”
In the study, 58 pediatric primary care practitioners were presented with vignettes describing two 15-year-old girls with depression. One scenario met the criteria for moderate depression and one for severe depression; neither patient was suicidal, the researchers explained. Most of the primary care practitioners were doctors, but some were nurse practitioners or other professionals.
The health care professionals were asked to make an initial treatment recommendation for each patient. Responses were compared with the PCPs’ knowledge of depression, attitudes toward dealing with psychosocial issues, and practice characteristics.
Only one-fourth of the PCPs said they would prescribe an antidepressant for the patient with moderate depression, while about one-third said they would for the patient with severe depression, according to the study’s findings.
Current guidelines recommend antidepressants and/or cognitive-behavioral therapy for teens with moderate to severe depression. Antidepressant medications are considered particularly effective for patients with severe depression, the researchers noted.
Most of the PCPs said they would refer the patients to a child and adolescent psychiatrist for medication management — 60 percent for the patient with moderate depression and 90 percent for the patient with severe depression.
Mental health consultation is recommended for severely depressed teens, but not necessarily those with moderate depression, the researchers said.
According to the researchers, the number of teens with depressive symptoms far outweighs the treatment capacity of the child psychiatry work force.
“For that reason, it’s especially important that PCPs who see adolescents be capable and confident in managing depression,” the researchers said in the study.
Antidepressants were about five times more likely to be recommended by PCPs who had access to an on-site mental health care provider, according to the study. All PCPs in the study were part of a large pediatric practice network that had access to licensed mental health therapists — some on-site and some in neighboring practices.
Providers who scored higher on a test of depression knowledge were about 70 percent more likely to recommend antidepressants, according to the findings. In contrast, those who felt a higher sense of personal burden when seeing patients for a mental health-related problem were less likely to prescribe antidepressants.
Radovic and her colleagues suggest steps to encourage “guideline-concordant” antidepressant prescribing by PCPs, including continued support and training in depression management, co-management with mental health care providers, and interventions to make PCPs more comfortable in dealing with patients’ psychosocial problems.
The study was published in the Journal of Developmental & Behavioral Pediatrics.
Source: Wolters Kluwer Health