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VNA of Care New England

Primary Care Docs Rarely Advise Antidepressants for Teens

Depression severity doesn't influence likelihood of recommendation; does affect child psychiatry referral
FRIDAY, Jan. 17, 2014 (HealthDay News) -- Few primary care providers (PCPs) recommend antidepressants for adolescents with depression, according to research published in the January issue of the Journal of Developmental & Behavioral Pediatrics.
Ann Radovic, M.D., from the Children's Hospital of Pittsburgh, and colleagues conducted a cross-sectional survey among 58 PCPs within a large pediatric network to examine the impact of symptom severity and provider characteristics for initial depression treatment decisions. Treatment decisions were compared in response to two vignettes, describing adolescents with moderate or severe symptoms of depression.
The researchers found that 25 and 32 percent of PCPs recommended an antidepressant for adolescents with moderate and severe symptoms, respectively. The likelihood of recommendation was not significantly affected by depression severity (odds ratio [OR], 1.58; P = 0.19). Severe depression correlated with a significantly increased likelihood of child psychiatry referral (OR, 5.50; P < 0.001), compared with moderate depression. PCPs with greater depression knowledge and access to an on-site mental health provider were more likely to recommend antidepressants (ORs, 1.72 [P = 0.009] and 5.13 [P = 0.02], respectively). Those PCPs who reported higher provider burden when addressing psychosocial concerns were less likely to recommend antidepressants (OR, 0.85; P = 0.02).
"PCPs infrequently recommended antidepressants for adolescents, regardless of depression severity," the authors write. "Continued PCP support through experiential training, accounting for provider burden when addressing psychosocial concerns, and co-management with mental health providers may increase PCPs' antidepressant prescribing."
Abstract (http://journals.lww.com/jrnldbp/Abstract/2014/01000/Primary_Care_Providers__Initial_Treatment.4.aspx )Full Text (subscription or payment may be required) (http://journals.lww.com/jrnldbp/Abstract/2014/01000/Primary_Care_Providers__Initial_Treatment.4.aspx )
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