Management Of Adolescent Depression Research Articles

A review of research advances in the clinical management of adolescent depression

With the change of time and the development of society, in recent years, the problem of depression among adolescents has attracted much attention in China and even in the world. Depression is a relatively common psychiatric disorder at this stage. Focusing on the clinical treatment methods of adolescent depression, this review summarizes and discusses the progress of psychotherapy, the progress of medication, and other physical therapy methods applied in todays clinic for treating adolescent patients with depression and finds that the psychotherapeutic method that is applied more in todays clinic is cognitive-behavioral therapy (CBT); medications such as fluoxetine are mostly used, but it is difficult to guarantee the safety of medication use, and the combination of Chinese and Western medications is often used in China. In China, a combination of Chinese and Western medicines is often used; at the same time, repetitive transcranial magnetic therapy is often used, and electroconvulsive therapy is occasionally used. At the same time, the combination of multiple therapies has a better effect.

Longitudinal Relationships Between Help-Seeking Intentions and Depressive Symptoms in Adolescents

PurposeCross-sectional studies have shown an association between lower help-seeking intentions and greater depressive symptoms among adolescents. However, no longitudinal study has examined the direction of this association. The current study investigated whether help-seeking intentions and depressive symptoms are reciprocally associated at the within-person (individual) level during early to mid-adolescence. MethodsLongitudinal data on help-seeking intentions and depressive symptoms in adolescents were obtained from a population-based birth cohort study (Tokyo Teen Cohort; N = 3,171) at four time points (10y, 12y, 14y, and 16y). A random intercept cross-lagged panel model was used to evaluate the within-person prospective associations between help-seeking intentions and depressive symptoms. ResultsAt the within-person level, significant associations were consistently observed between antecedent greater depressive symptoms and subsequent lower help-seeking intentions across all time points (10y–12y: standardized regression coefficient (β) = −0.12, p < .001; 12y–14y: β = −0.07, p < .05; and 14y–16y: β = −0.09, p < .01). Meanwhile, significant within-person associations were partly observed between antecedent lower help-seeking intentions and subsequent greater depressive symptoms from 10y to 12y (β = −0.07, p < .05) and from 14y to 16y (β = −0.12, p < .001). These prospective associations were almost the same when adjusted for the number of potential confidants as a time-varying confounder. DiscussionAdolescents with worsening depressive symptoms may become increasingly reluctant to seek help over time. Proactive early recognition and intervention with support from parents, teachers, and other individuals may facilitate the management of depression in adolescents.

Diagnosis and management of depression in adolescents.

Diagnosis and management of depression in adolescents.

Experiences of adolescents and parents on the mental health management of depression in adolescents, North West province, South Africa.

BackgroundLiving with or managing an adolescent suffering from depression predisposes the adolescent and parents to various experiences, considering the multifactorial nature of depression and associated symptoms.ObjectiveThis study explored and described the experiences of adolescents and their parents on the mental health management of depression in the North West province (NWP), South Africa.MethodA qualitative, exploratory, descriptive, contextual research design was adopted. Data was collect from two mental health care institutions and two mental health care units attached to two general hospitals in the NWP, SA. Thirty-two participants (18 adolescents and 14 parents) were purposefully selected for the study. Data were collected through individual interviews and analysed using Tesch’s open-coding method to generate themes and categories which were presented with the concurrent support of participants direct quotations.ResultsThe study revealed that the experiences of adolescents with depression and their parents taking care of them at homes include the following: emotional distress, poor coping mechanisms, financial burden, repeated suicidal attempts, negative attitudes from support systems and withdrawal behaviours. Appropriate therapeutic environments, ongoing monitoring by mental healthcare practitioners and adequate support systems were suggested by participants as management approaches that could enhance the recovery of adolescents from depression.ConclusionThe findings revealed the devastating experiences of adolescents with depression and their parents taking care of them in their various homes which confirms the dire need for attention on the plights of these groups in order to facilitate adolescents’ recovery and strengthen the adolescents’ and parents’ coping mechanisms for a healthier family.

Conceptual Framework for the Psychosocial Management of Depression in Adolescents in the North West Province, South Africa

Conceptual Framework for the Psychosocial Management of Depression in Adolescents in the North West Province, South Africa

An open label prospective clinical trial assessing the role of individualized homoeopathic medicine in management of adolescent depression

Background: “Depression–Let’s talk” was the slogan for World Health Day 2017. Depression is an extremely common illness which contributes to significant disease burden at national and global levels, especially of the adolescent age group. Objectives: To ascertain the role of homoeopathic medicines in the management of moderate depression in adolescent age group. Material and Methods: 44 patients were enrolled. An open observational clinical trial was conducted at Out Patient Department of National Institute of Homoeopathy, Kolkata. HDRS-17 and PHQ-9 Score level was recorded at baseline, at 3 months and after 6 months of treatment for assessing the primary and secondary outcomes respectively. Medicines were prescribed on the basis of strict homoeopathic principles. Result: 12 patients dropped-out, 32 patients completed the trial. Protocol–compliant sample (n=32) was analyzed at the end. HDRS-17 Score Baseline Vs HDRS-17 Score at 3 months Vs HDRS-17 Score at 6 months: Mean was reduced from 15.5 (SD 3.464) to 8.81 (SD 2.78), to 8.71 (SD 3.87) 95% CI 1.29 to 1.02 to 1.42, P

Perceptions of mental health nurses about psychosocial management of depression in adolescents, North West province, South Africa

BackgroundDepression in adolescents is a multifactorial global public health concern, with devastating consequences on the sufferer. The prevalence of depression amongst this age group is on the rise, and thus there is the need for greater attention.AimTo explore and describe the perceptions of mental health nurses regarding the psychosocial management of depression in adolescents in North West province, South Africa.SettingThe study was conducted in two mental healthcare institutions and two mental healthcare units within two general hospitals in North West province, South Africa.MethodA qualitative, explorative, descriptive and contextual research design was used in conducting this study. Data were collected through focus group discussions from four groups of mental health nurses from each of the mental healthcare institutions and mental healthcare units with 18 mental health nurses. Data were analysed using Tesch’s open coding method.ResultsTwo themes emerged from the study: comprehensive psychosocial management and involvement of different stakeholders.ConclusionThe findings revealed clear psychosocial management for depression in adolescents. Adopting the findings of this study could improve depressive symptoms and curtail the prevalence of depression amongst adolescents in the North West province, South Africa.

Implementation of Universal Adolescent Depression Screening: Quality Improvement Outcomes

Introduction Despite the increasing incidence of adolescent depression, suicide and evidence-based recommendations for adolescent depression screening, 70% of teens report not discussing depression with their provider. The aim of this quality improvement project was to improve the identification and management of adolescent depression by implementing a practice-based, universal depression screening. Method The Patient Health Questionnaire-9 modified for Adolescents was implemented during annual wellness visits for adolescents aged 12–18 years over 3 months. Retrospective chart reviews were conducted to determine a change in the rates of depression screening, depression diagnoses, referrals to mental health, and pharmaceutical treatment of depression. Results Pre/postimplementation data were compared. Documented adolescent depression screening increased from 0% to 74.5%. Increased rates of diagnosed depression (12.1%), mental health referrals (8%), and pharmaceutical treatment of depression (4.9%) were clinically and statistically significant. Discussion Adopting evidence-based recommendations for universal depression screening in pediatric primary care can improve the early diagnosis and management of adolescent depression. Despite the increasing incidence of adolescent depression, suicide and evidence-based recommendations for adolescent depression screening, 70% of teens report not discussing depression with their provider. The aim of this quality improvement project was to improve the identification and management of adolescent depression by implementing a practice-based, universal depression screening. The Patient Health Questionnaire-9 modified for Adolescents was implemented during annual wellness visits for adolescents aged 12–18 years over 3 months. Retrospective chart reviews were conducted to determine a change in the rates of depression screening, depression diagnoses, referrals to mental health, and pharmaceutical treatment of depression. Pre/postimplementation data were compared. Documented adolescent depression screening increased from 0% to 74.5%. Increased rates of diagnosed depression (12.1%), mental health referrals (8%), and pharmaceutical treatment of depression (4.9%) were clinically and statistically significant. Adopting evidence-based recommendations for universal depression screening in pediatric primary care can improve the early diagnosis and management of adolescent depression. Jeff Bose, Nurse Practitioner, Kiddie West Pediatric Center, Columbus, OH. Rosie Zeno, Assistant Professor of Clinical Nursing and Director of MS in Nursing Program, The Ohio State University, Columbus, OH. Barbara Warren, Professor of Clinical Nursing and Psychiatric Mental Health Nursing Across the Lifespan Specialty Track Director, The Ohio State University, Columbus, OH. Loraine T. Sinnott, Research Statistician, The Ohio State University, Columbus, OH. Elizabeth A. Fitzgerald, Associate Professor of Clinical Nursing, The Ohio State University, Columbus, OH.

Addressing National Workforce Shortages by Funding Child Psychiatry Access Programs.

* Abbreviations: CPAP — : Child Psychiatry Access Program PediPRN — : Pediatric Psychiatry Resource Network For decades, the medical community has been dealing with a shortage of child psychiatrists in the United States. A study published in Pediatrics in November 2019 demonstrated that although the number of child psychiatrists increased in the last 10 years, there are still not enough to meet demand, and counties in the United States with lower levels of income and education particularly struggle to meet demand.1 Thirty-six states have fewer than 10 child psychiatrists per 100 000 children, with only 3.3 child psychiatrists per 100 000 in the most extreme case.1 This imbalance translates into wait times of over 11 months for an appointment with a child psychiatrist in some areas.2 Furthermore, up to 20% of children in the United States have a mental health disorder, with suicide the second most common cause of death among 12 to 17 year olds.3 A commentary by David Axelson, MD,4 published alongside the Pediatrics study, called for innovation in the delivery of mental health services to children to leverage the existing workforce to make the greatest possible impact. Over the years, many proposed solutions have addressed the workforce shortage, including developing accelerated training pathways for child psychiatrists, recruiting nurse practitioners to the field, and expanding federal loan forgiveness programs, but the shortage has persisted despite these efforts. One … Address correspondence to Kathryn Sullivan, BA, Warren Alpert Medical School of Brown University, Box G-9040, Providence, RI 02912. E-mail: kathryn_sullivan{at}brown.edu

Social isolation as a core feature of adolescent depression: a qualitative study in Porto Alegre, Brazil

ABSTRACT Purpose The goal of this study was to explore the perspectives of different stakeholders regarding the experiences of adolescent depression in Porto Alegre, Brazil. Methods We conducted 54 key-informant interviews with adolescents, parents, social workers, health workers, educators, and policy makers and two focus group discussions with 5 adolescents and 6 parents. Data were analysed using a framework approach and guided by the adolescents’ personal narratives, with adult stakeholders’ views supplementing these perspectives. Results Four main themes emerged, creating a relational model of adolescent depression that highlights isolation as a central component of the experience. In relation to the self, the experience of depression led to a feeling of detachment from others resulting from the sensation that usual interactions did not have the same meaning as before. This disruption of interactions is perceived as self-isolation and is described in relation to coping mechanisms. Conclusion These findings shed light on important aspects of the identification and management of adolescent depression in Brazil. Since social interaction was a core component of the descriptions and experiences of depression, we speculate that promising interventions are those that could enhance the promotion of a supportive environment and interpersonal relationships.

Identification and Management of Adolescent Depression in a Large Pediatric Care Network: Erratum.

Identification and Management of Adolescent Depression in a Large Pediatric Care Network: Erratum.

Psychosocial management of depression in adolescent learners: Results and implications of a Nigerian study

This study explored the perceptions of adolescent learners, teachers, and parents on the psychosocial management of adolescent depression in a district of Lagos State, Nigeria. Data were collected from 24 participants (10 adolescent learners, 6 teachers, 2 principals, and 6 parents) through in-depth individual interviews. Following thematic analysis, findings revealed adolescents to priorities low mood and lack of concentration aspects of depression experiences, while teachers and principals focused on low self-esteem and bullies. Compared to the adolescents and school personnel, the parents and guardians appeared to be more invested in feelings of helplessness, hopelessness, poor emotional control, and anxiety of the depressed adolescents. In the management of adolescent depression, stakeholder’s priorities need to be taken into account for comprehensive interventions.

Identification and Management of Adolescent Depression in a Large Pediatric Care Network.

Primary care has been promoted as a setting to identify and manage adolescent depression. This study examined primary care-based adolescent depression identification and follow-up care when elevated symptoms were identified. Data came from a large pediatric care network with an organizational recommendation to screen for depression at age 16 well-visits using an electronic health record (EHR)-integrated standardized measure. Analyses examined rates of screening and elevated symptoms, pediatricians' initial responses to elevated scores, and types of follow-up care received over 1 year using retrospective EHR data extraction and manual chart reviews. Across program sites, 76.3% (n = 6981) of patients attending their age 16 well-visits were screened. About one-quarter had an elevated score (19.2% mild and 6.7% moderate-to-severe), many of whom received active follow-up on their well-visit date. Over 1 year, three-fourths of patients with scores in the moderate-to-severe range and 40.0% of patients with scores in the mild range received follow-up care (e.g., antidepressant prescriptions) as per EHR extraction. Follow-up rates were higher as per manual chart reviews. Routine adolescent depression screening is feasible across diverse primary care sites. Most patients with elevated scores were not already receiving behavioral health services, suggesting screening identified previously undetected concerns. In turn, many adolescents with elevated scores initiated treatment after screening, which indicates providing screen results at the point of care may facilitate pediatrician actions. Still, gaps in follow-up care demonstrate the need for greater investment in primary care-based behavioral health services to support high-quality treatment and ultimately decrease the burden of adolescent depression.

The Association Between Burnout and Pediatrician Management of Adolescent Depression.

Objective: Given the increased demand for pediatric primary care providers to manage adolescent depression, the current study examines the association between burnout and provider comfort and perception of feasibility managing adolescent depression. Method: Data were collected from 52 pediatricians at a Midwest academic health center. Results: Higher scores on depersonalization were associated with lower provider-reported comfort managing adolescent depression. Emotional exhaustion and personal accomplishment were not associated with provider-reported comfort managing adolescent depression. None of the burnout domains were associated with the provider-reported perception of the feasibility managing adolescent depression in this setting. Limitations and recommendations for future research regarding the impact of behavioral health training on burnout are discussed. Conclusions: The interpersonal stress dimension of burnout is associated with less comfort managing depression. Adding positive systematic interventions, such as behavioral health trainings that support pediatricians in the management of behavioral health may have impact on burnout.

Adolescent Depression Curriculum Impact on Pediatric Residents' Knowledge and Confidence to Diagnose and Manage Depression.

Despite the need for pediatricians to diagnose and manage adolescent depression, few pediatric residency curricula exist. This study evaluated the impact of an adolescent depression curriculum on pediatric residents' knowledge and confidence to manage depression. A novel, case-based, adolescent depression curriculum simulating patient-provider continuity was developed and implemented within an adolescent medicine (AM) rotation. The curriculum addressed seven domains critical for diagnosis and management of adolescent depression. Participants were recruited from the pediatric residency at one institution. A survey assessed residents' demographics, prior training, and self-assessed knowledge and confidence within each domain using a retrospective pre-post evaluation. Wilcoxon signed-rank test evaluated changes in knowledge and confidence. Forty-two of a total 51 residents (82%) completed the curriculum and survey during their AM rotation. Residents reported that within their continuity clinic, 45% (n= 19) had never initiated medication for depression, and 60% (n= 25) did not manage their adolescent patients' depression medications. Comparisons before and after participation in the curriculum, using the retrospective pre-post survey, demonstrated increased self-assessed knowledge (p < .001, for each domain) and confidence (p < .001, for each domain). In this study, few residents reported experience initiating medication or managing adolescent depression in the continuity clinic. Residents demonstrated increased self-assessed knowledge and confidence to diagnose and manage adolescent depression after participation in a case-based adolescent depression curriculum simulating patient-provider continuity. Incorporation of training on management of adolescent depression into AM rotation may be a feasible option to standardize training within pediatric residency.

Implementing American Academy of Pediatrics guidelines on adolescent depression screening in a pediatric primary care clinic

Background From 2005 to 2014, the 12-month prevalence of major depressive episode (MDE) has increased from 8.7% to 11.3% in adolescents of the United States. In Alabama, 10.7% of adolescents from 12 to 17 years old had at least one MDE in the prior year. Due to the severe shortage of child and adolescent psychiatrist, pediatrician's role in identification and management of adolescent depression has been emphasized. Local Problem and intended improvement In our continuity clinic at a pediatric residency program, we sought to use QI to reliably screen for depression to meet …

Management of Depression in Adolescents in Japan.

Objectives: In Japan, there are currently no approved antidepressant treatments for pediatric patients with depression. This study aimed to estimate the prevalence of depression among adolescents under medical care in Japan, the pharmacological treatments used, and the perceived unmet needs among the medical specialties treating depression in the pediatric population. Methods: The study was conducted in November 2014 as an internet survey among physicians in clinical practice. It included a sample of 731 physicians with the potential to treat adolescent patients with depression and 161 physicians who had treated at least one adolescent with depression with pharmacotherapy in the previous 12 months. Of the sample of 161 treating physicians, 60 were internal medicine specialists, 73 were psychiatrists, and 28 were certified specialists from the Japanese Society of Child and Adolescent Psychiatry, Japanese Society of Psychosomatic Medicine Pediatrics, or Japanese Society of Pediatric Psychiatry and Neurology. The participants completed questionnaires concerning their patient population with depression, drug-treated population, and drugs prescribed. Results: Estimates of prevalence data indicated that there were ∼550,000 adolescent patients with depression in Japan (10% of the patient population with depression) under medical care of different medical specialties; ∼64% of these patients were receiving pharmacotherapy. Pharmacotherapy for adolescents with depression was prescribed mainly by psychiatrists (62% of prescriptions for these patients). The most common first-choice agent was sertraline (23% of respondents) followed by anxiolytics (17%) and fluvoxamine (13%), while antipsychotics were the preferred choice for 7%. Conclusion: The study indicates a high prevalence of depression among adolescents in Japan. These patients are seen by different medical specialties; the use of pharmacotherapy is relatively common and comprises various drug classes, including antidepressants, anxiolytics, and antipsychotics. This study shows that there is a medical need for approved treatments for adolescents with depression in Japan.

8.1 Implementation of a Care Pathway for the Management of Adolescent Depression in Pediatric and Mental Health Settings

8.1 Implementation of a Care Pathway for the Management of Adolescent Depression in Pediatric and Mental Health Settings

4.6 Efficacy of Presenting the Guidelines for Adolescent Depression in Primary Care (GLAD-PC) to Improve Pediatric Trainees’ Knowledge and Comfort Regarding Screening and Managing Adolescents With Depression

In an effort to bridge the management gap between child/adolescent psychiatrists and pediatricians for adolescent depression, the goal of this study was to assess whether a lecture-style presentation of the 2018 revised Guidelines for Adolescent Depression in Primary Care (GLAD-PC) could improve the awareness and comfort of the screening and initial management of adolescent depression in future pediatricians.

8.4 Development of an Integrated Clinical Informatics System to Support a Unified System of Care for Adolescent Depression

Clinical informatics systems are powerful tools for tracking and improving care across health systems. This session will describe technological advances in the development of a unified system for the management of adolescent depression in an academic medical center. We will detail responses to challenges in harmonizing systems for managing adolescent depression across varied pediatric and mental health settings.