Zuckerbrot RA, Cheung A, Jensen PS, Stein REK, Laraque D; GLAD-PC STEERING GROUP.
OBJECTIVES: To update clinical practice guidelines to assist primary care (PC)
clinicians in the management of adolescent depression. This part of the updated
guidelines is used to address practice preparation, identification, assessment,
and initial management of adolescent depression in PC settings.
METHODS: By using a combination of evidence- and consensus-based methodologies,
guidelines were developed by an expert steering committee in 2 phases as informed
by (1) current scientific evidence (published and unpublished) and (2) draft
revision and iteration among the steering committee, which included experts,
clinicians, and youth and families with lived experience.
RESULTS: Guidelines were updated for youth aged 10 to 21 years and correspond to
initial phases of adolescent depression management in PC, including the
identification of at-risk youth, assessment and diagnosis, and initial
management. The strength of each recommendation and its evidence base are
summarized. The practice preparation, identification, assessment, and initial
management section of the guidelines include recommendations for (1) the
preparation of the PC practice for improved care of adolescents with depression;
(2) annual universal screening of youth 12 and over at health maintenance visits;
(3) the identification of depression in youth who are at high risk; (4)
systematic assessment procedures by using reliable depression scales, patient and
caregiver interviews, and Diagnostic and Statistical Manual of Mental Disorders,
Fifth Edition criteria; (5) patient and family psychoeducation; (6) the
establishment of relevant links in the community, and (7) the establishment of a
safety plan.
CONCLUSIONS: This part of the guidelines is intended to assist PC clinicians in
the identification and initial management of adolescents with depression in an
era of great clinical need and shortage of mental health specialists, but they
cannot replace clinical judgment; these guidelines are not meant to be the sole
source of guidance for depression management in adolescents. Additional research
that addresses the identification and initial management of youth with depression
in PC is needed, including empirical testing of these guidelines.
