Primary care provider training in screening, assessment, and treatment of adolescent depression

Elise M Fallucco; Robbin D Seago; Steven P Cuffe; Dale F Kraemer; Tim Wysocki

doi:10.1016/j.acap.2014.12.004

Primary care provider training in screening, assessment, and treatment of adolescent depression

Acad Pediatr. 2015 May-Jun;15(3):326-32. doi: 10.1016/j.acap.2014.12.004. Epub 2015 Mar 29.

Authors

Elise M Fallucco¹, Robbin D Seago², Steven P Cuffe³, Dale F Kraemer⁴, Tim Wysocki²

Affiliations

¹ Nemours Center for Health Care Delivery Science, University of Florida, Jacksonville, Fla; Division of Psychiatry and Psychology, Nemours Children's Clinic, University of Florida, Jacksonville, Fla. Electronic address: Elise.Fallucco@nemours.org.
² Nemours Center for Health Care Delivery Science, University of Florida, Jacksonville, Fla.
³ Department of Psychiatry, University of Florida, Jacksonville, Fla.
⁴ Center for Health Equity and Quality Research and Department of Neurology, University of Florida, University of Florida, Jacksonville, Fla.

PMID: 25824896
DOI: 10.1016/j.acap.2014.12.004

Abstract

Objective: Adolescent depression is underrecognized and undertreated. Primary care providers (PCP) require training to successfully identify adolescents with depression. We examined the effects of a PCP training program in the screening, assessment, and treatment of adolescent depression (SAT-D) on adolescents' reports of PCP screening for adolescent depression at annual well visits and PCP SAT-D confidence and knowledge.

Methods: PCP (n = 31) attended one SAT-D training program consisting of a 60-minute SAT-D seminar and a 60-minute standardized patient session where PCP practiced SAT-D skills. A pre-post design evaluated effects of training on PCP depression screening practices as reported by 3 groups of adolescent patients at well visits (n = 582 before, n = 525 at 2 to 8 months after training, n = 208 at 18 to 24 months after training). A generalized linear mixed effects logistic regression controlled for provider and patient demographics that may have influenced depression screening. PCP SAT-D self-reported confidence and objectively tested knowledge were assessed at baseline, immediately after training, and at 4 to 6 months after training.

Results: On the basis of the regression analysis, PCP screening for adolescent depression increased significantly from pretraining (49%) to 2 to 8 months after training (68%, odds ratio 2.78, 95% confidence interval 2.10-3.68) and 18 to 24 months after training (74%, odds ratio 3.17, 95% confidence interval 2.16-4.67; both P < .0001). PCP SAT-D confidence and knowledge also significantly improved.

Conclusions: PCP SAT-D training resulted in significant increases in primary care screening for adolescent depression that were maintained up to 24 months after training. Future studies should determine if changes in PCP screening improve identification of adolescent depression and patient outcomes for adolescents with depression.

Keywords: adolescent depression; primary care; screening; standardized patient.

Publication types

Research Support, U.S. Gov't, P.H.S.

MeSH terms

Adolescent
Depression / diagnosis*
Depressive Disorder / diagnosis*
Female
Humans
Linear Models
Logistic Models
Male
Mass Screening / statistics & numerical data*
Odds Ratio
Patient Simulation
Physicians, Primary Care / education*
Primary Health Care*
Simulation Training

Grants and funding

5U79SM059939-04/SM/CMHS SAMHSA HHS/United States