Hausärztliche Primärversorgung

Abstract

Based on guidelines and recommendations of experts this paper describes how depression in children and adolescents can be recognized and managed in primary care. Depression in school age children often presents as diminished attention and somatic complaints, such as sleep problems or tiredness and in adolescents as loss of drive and depressed mood. Interviews with children, adolescents and parents aim at establishing a relationship and identifying depressive symptoms. It is difficult and challenging to achieve simultaneous contact with children and parents. Rating scales help the physician to structure an assessment of behaviour. Questions on indications of dangerous behaviour must be documented. Physicians showed much more competence in psychosocial issues in 5 min training interviews than they were aware of. A supportive and trustful relationship, counseling and monitoring constitute the core competency in primary care. If depressive symptoms last longer or are severe psychotherapy and antidepressive medication are indicated. Consultation of a child and adolescent psychiatrist is needed immediately if a suicidal tendency is suspected and quickly for suspected additional psychiatric problems. The availability of specialists is an indicator of the quality of cooperation. Basic knowledge of psychiatric problems in children, skills in interviewing and a supportive attitude are the essential instruments to feel comfortable in the role of counselor in primary care.