Addressing Adolescent Depression in Primary Care: Building Capacity Through Psychologist and Pediatrician Partnership
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Addressing Adolescent Depression in Primary Care: Building Capacity Through Psychologist and Pediatrician Partnership Lisa H. Costello1 · Christina Suh2 · Bridget Burnett1,2 · Kimberly Kelsay1 · Maya Bunik2 · Ayelet Talmi1,2
© Springer Science+Business Media, LLC, part of Springer Nature 2019
Abstract Early identification and treatment of depression during adolescence can contribute to healthier outcomes across the lifespan, yet adolescent depression has been underidentified and undertreated. The American Academy of Pediatrics’ (AAP) Guidelines for Adolescent Depression in Primary Care (GLAD-PC) were created to enhance the identification and treatment of adolescent depression. Integrated psychologists in a pediatric primary care setting partnered with providers and clinic staff to implement an adolescent depression screening initiative and transform primary care practice around identification and management. From January 2017 through August 2018, 2107 adolescents between the ages of 11 and 18 were screened using the PHQ-9A. Eleven percent (n = 226) of adolescents had an elevated screen with a score of ≥ 10 and 7% (n = 151) screened positive for suicidal ideation. Identification of depressive symptoms led to increased integrated behavioral health services delivered by psychologists, psychiatrists, and psychology trainees. Psychologists integrated in primary care can support primary care practices to develop service delivery systems aligned with AAP’s GLAD-PC and address the diverse implementation barriers associated with incorporating clinical practice guidelines in real-world settings. Universal screening for adolescent depression and response protocols were successfully implemented in a pediatric primary care clinic under the leadership of psychologists and pediatrician partners. Keywords Adolescent · Major depressive disorder · Primary care · Integrated behavioral health · Screening A majority of mental health disorders that are present in adulthood originate in childhood or adolescence (Merikangas et al., 2010). In the United States, the lifetime prevalence rate of major depressive disorder (MDD) among adolescents is around 11%, with 30% of youth with MDD experiencing suicidality (Avenevoli, Swendsen, He, Burstein, & Merikangas, 2015). Although depression is common in adolescence, it is often underidentified (Cheung, Kozloff, & Sacks, 2013) and undertreated (Avenevoli et al., 2015) despite the Lisa H. Costello and Christina Suh have contributed equally to the work * Lisa H. Costello [email protected] 1
Department of Psychiatry, University of Colorado School of Medicine, and Pediatric Mental Health Institute, Children’s Hospital Colorado, 13123 East 16th Avenue, B130, Aurora, CO 80045, USA
Department of Pediatrics, University of Colorado School of Medicine, General Pediatrics, Children’s Hospital Colorado, Aurora, USA
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existence of effective interventions (Cheung, Zuckerbrot, Jensen, Laraque, & Stein, 2018; Zuckerbrot, Cheung, Jensen, Stein, & Laraque, 2018). Only about one-third of youth
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