Improving quality of primary care reduces depression and improves quality of life in adolescents

摘要

Untreated depression in teenagers contributes to school and relationship difficulties, family problems, alcohol and substance abuse, and increased suicide rates, and can herald the onset of a lifelong disorder. Primary care can be an effective place to identify depressed teens and initiate treatment. This study demonstrates that it is feasible to introduce into primary care settings a treatment programme for teenagers. The authors developed a chronic illness model for treating teenage depression, incorporating an innovative and flexible intervention, patient choice of treatment options, a move towards evidence-based care, and-most importantly-organisational changes to support the programme (however, the role of the "expert leaders" responsible for this at each site is not expanded upon). The intervention involved many components: providing information about depression; offering the participants choices of treatments; providing someone for the teen to talk to; the cognitive behaviour therapy itself; and organisational changes. It would have been useful to assess which of these components had the greatest impact on outcomes, and whether any of their effects were synergistic. One outstanding question remains: how best to identify teenagers in primary care who are depressed. In this study 4034 teens were screened. As 18 more teenagers in the intervention group improved, if the intervention had been available to everyone in the study, by extrapolation only 36 would have improved, or one for every 112 teenagers screened. While evidence regarding the benefits of screening teenagers is lacking, incorporating two questions concerning mood and anhedonia in a primary care provider's assessment can be as effective as administering a full screening instrument. Organisational changes in primary care settings that lead to all primary care providers asking these two questions routinely each time they see a teen may prove to be the most efficient way to identify depressed teenagers.