New Guidelines For Managing Teen Depression On The Frontlines

For the first time ever, frontline healthcare workers in North America will have clear guidelines and a toolkit for the management of adolescent depression.

Recognizing a gap in clinical guidance for primary care providers in the management of adolescent depression, a group of psychiatric researchers in North America, led by Sunnybrook’s Dr. Amy Cheung, collaborated to establish the Guidelines for Adolescent Depression in Primary Care (GLAD-PC), for the management of adolescent depression in the primary care setting.

“Although additional research is urgently needed to further guide primary care clinicians, this report provides the first-ever evidence- and expert consensus-derived guidelines to guide primary care clinicians’ management of adolescent depression,” says Dr. Amy Cheung, a lead investigator in the study and a youth psychiatrist at Sunnybrook Health Sciences Centre.

The guidelines, published in the November 2007 issue of the journal Pediatrics, are intended to address the lack of recommendations regarding the identification, assessment, diagnosis, initial management, treatment and ongoing management of depression in adolescents aged 10 to 21 years in primary care settings in Canada and the United States.

“Because of barriers to adolescents receiving specialty mental health services, primary care settings have become the de facto mental health clinics for this population, although many primary care clinicians feel inadequately trained, supported, or reimbursed for the management of this disorder,” says Dr. Cheung, also an Assistant Professor in the Department of Psychiatry within the Faculty of Medicine at University of Toronto. “Review of the evidence suggests that primary care clinicians who have appropriate training and are attempting to deliver comprehensive health care should be able to identify and initiate management of adolescent depression with the use of tools and management protocols provided. Although more work needs to be done, these components of the identification, assessment, initial management, treatment and ongoing management of adolescent depression in primary care can be done.”

The guidelines are intended to assist clinicians in family medicine, pediatrics, nursing, and internal medicine who may be the first, and sometimes only, clinicians to identify, manage, and possibly treat adolescent depression. They may also be helpful for allied health professionals who care for adolescents.

“These guidelines cannot replace clinical judgment, and they should not be the sole source of guidance for adolescent depression management,” says Dr. Cheung, who in recent years has made headlines nation-wide for bringing awareness to the need for increased service use and accessibility for teens with depression. “Nonetheless, they may assist primary care clinicians in the management of depressed adolescents in an era of great clinical need and a shortage of mental health specialists.”

They provide information and guidelines for the identification, assessment and initial management of adolescent depression in the primary care setting, and also for treatment and ongoing management. The guidelines are accompanied by a toolkit, available for download at no cost at www.glad-pc.org, which includes: screening/assessment instruments, information sheets on the developmental considerations in the diagnosis of depression, an assessment algorithm/flow sheet, fact sheet/family educational materials, educational materials on suicide prevention/safety planning, treatment algorithm/flow sheet, treatment choices, referral information, authorization to disclose protected health information between the primary care provider and the mental health professional, follow-up scripts for management, and self-management tools.

Over the last three years, Sunnybrook and University of Toronto joined forces with the Center for the Advancement of Children’s Mental Health at Columbia University, the New York Forum for Child Health, New York chapters of the American Academy of Pediatrics, and the REACH Institute, along with leading experts across Canada and the United States, to address the need for a synthesis of knowledge in this area. The result of this initiative was the development of the GLAD-PC.

Major depression in adolescents is recognized as a serious psychiatric illness with extensive acute and chronic morbidity and mortality. It is a typically recurrent disorder that follows patients well into their adult years. Dr. Cheung’s past research shows that only 50 per cent of adolescents with depression are diagnosed before they reach adulthood. In primary care, as many as two in three depressed youth are not identified by their primary care clinicians and do not receive any kind of care.

Sunnybrook Health Sciences Centre is transforming health care through the dedication of its more than 10,000 staff, physicians and volunteers who provide compassionate and innovative patient focused care. An internationally recognized leader in academic research and education and an affiliation with the University of Toronto distinguishes Sunnybrook as one of Canada's premier health sciences centres. Sunnybrook specializes in caring for newborns, adults and the elderly, treating and preventing cancer, neurological and psychiatric disorders, cardiovascular disease, orthopaedic and arthritic conditions and traumatic injuries.