Promoting partnerships between primary health care providers, families, and the community to support early identification of children and youth with special needs and comprehensive care within a primary care medical home.
Distributed by: Snohomish Health District Contributors: University of Washington, Center on Human Development & Disability (CHDD) & the Washington State Department of Health (DOH). Issue author: Sophie Lu, MN, ARNP, Developmental Pediatric Nurse Practitioner, UW CHDD. Reviewers: Ellen Silverman, RN, PhD, Nurse Consultant, DOH; Lacey Coffin-Greene, Program Manager, Washington Chapter of the American Academy of Pediatrics (WCAAP)
|
|
|
|
Adolescent Depression: Screening and Management in Primary Care
|
|
|
|
|
Studies have indicated that only 50% of adolescents with depression are diagnosed before reaching adulthood. i Research has also revealed that up to 9% of teenagers meet criteria for depression at any one time, and in primary care (PC) settings prevalence rates are likely higher (up to 28%). ii In 2016, an estimated 3.1 million or 12.8% of adolescents aged 12 to 17 years in the United States had at least one major depressive episode with an estimated 2.2 million of this population having at least one major depressive episode with severe impairment. Of adolescents with major depressive episode, approximately 70% had severe impairment, or 9% of the U.S. population aged 12 to 17. The prevalence of major depressive episode was higher among adolescent females (19.4%) compared to males (6.4%), and was highest among adolescents reporting two or more races (13.8%). iii
|
|
|
|
The American Academy of Pediatrics (AAP) recently published updated guidelines for depression in youth aged 10 to 21 years. These guidelines address the screening, identification, assessment, diagnosis, treatment and ongoing management of depression in PC.
Risk factors for depression may be biological (i.e. family history of depression, chronic medical illness, obesity), psychological (i.e. history of suicide attempts, ineffective coping skills, low self-esteem, negative body image) or environmental (i.e. poor peer relationships, decreased physical activity, increased parental conflict, poor academic performance, low socioeconomic status, substance use). Common symptoms of depressive disorders are:
|
|
|
|
|
Focus: Two Validated Mental Health Screening Instruments
|
|
|
|
|
|
Initial Management of Depression Recommendations from Seattle Children’s Partnership Access Line (PAL) Primary Care Principles for Child Mental Health iv
|
|
|
|
|
References [i] Zuckerbrot, R. A., Cheung, A., Jensen, P. S., Stein, R. K., & Laraque, D. (2018). Guidelines for Adolescent Depression in Primary Care (GLAD-PC): Part I. Practice Preparation, Identification, Assessment, and Initial Management. Pediatrics, 141(3), 1-21. doi:10.1542/peds.2017-4081 [ii] Cheung, A. a., Zuckerbrot, R. A., Jensen, P. S., Laraque, D., & Stein, R. K. (2018). Guidelines for Adolescent Depression in Primary Care (GLAD-PC): Part II. Treatment and Ongoing Management. Pediatrics, 141(3), 1-16. doi:10.1542/peds.2017-4082 [iii] National Institute of Mental Health website. Major Depression. https://www.nimh.nih.gov/health/statistics/major-depression.shtml [iv] Hilt, R. (2017). Seattle Children’s Primary Care Principles for Child Mental Health. Version 7.1. 2017-2018.
|
|
|
|
Special Needs Information and Resources
|
|
|
|
|
|
|
|