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Brief Summary

GUIDELINE TITLE

Guidelines for Adolescent Depression in Primary Care (GLAD-PC): I. Identification, assessment, and initial management.

BIBLIOGRAPHIC SOURCE(S)

GUIDELINE STATUS

This is the current release of the guideline.

BRIEF SUMMARY CONTENT

 
RECOMMENDATIONS
 EVIDENCE SUPPORTING THE RECOMMENDATIONS
 IDENTIFYING INFORMATION AND AVAILABILITY
 DISCLAIMER

 Go to the Complete Summary

RECOMMENDATIONS

MAJOR RECOMMENDATIONS

Definitions for grades of evidence (A-D) and strengths of recommendation (weak, fair, strong, very strong) are provided at the end of the "Major Recommendations" field.

Identification

Recommendation 1: Patients with depression risk factors (such as history of previous episodes, family history, other psychiatric disorders, substance abuse, trauma, psychosocial adversity, etc) should be identified (grade of evidence: C; strength of recommendation: very strong) and systematically monitored over time for the development of a depressive disorder (grade of evidence: C; strength of recommendation: very strong).

Assessment/Diagnosis

Recommendation 1: Primary care (PC) clinicians should evaluate for depression in adolescents at high risk as well as those who present with emotional problems as the chief complaint (grade of evidence: B; strength of recommendation: very strong). Clinicians should assess for depressive symptoms on the basis of diagnostic criteria established in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) or International Classification of Diseases, 10th Revision (grade of evidence: B; strength of recommendation: very strong) and should use standardized depression tools to aid in the assessment (grade of evidence: A; strength of recommendation: very strong).

Recommendation 2: Assessment for depression should include direct interviews with the patients and families/caregivers (grade of evidence: B; strength of recommendation: very strong) and should include the assessment of functional impairment in different domains (grade of evidence: B; strength of recommendation: very strong) and other existing psychiatric conditions (grade of evidence: B; strength of recommendation: very strong).

Initial Management of Depression

Recommendation 1: Clinicians should educate and counsel families and patients about depression and options for the management of the disorder (grade of evidence: C; strength of recommendation: very strong). Clinicians should also discuss limits of confidentiality with the adolescent and family (grade of evidence: D; strength of recommendation: very strong).

Recommendation 2: Clinicians should develop a treatment plan with patients and families (grade of evidence: C; strength of recommendation: very strong) and set specific treatment goals in key areas of functioning, including home, peer, and school settings (grade of evidence: D; strength of recommendation: very strong).

Recommendation 3: The PC clinician should establish relevant links/collaboration with mental health resources in the community (grade of evidence: B; strength of recommendation: very strong), which may include patients and families who have dealt with adolescent depression and are willing to serve as resources to other affected adolescents and their family members (grade of evidence: D; strength of recommendation: very strong).

Recommendation 4: All management must include the establishment of a safety plan, which includes restricting lethal means, engaging a concerned third party, and developing an emergency communication mechanism should the patient deteriorate, become actively suicidal or dangerous to others, or experience an acute crisis associated with psychosocial stressors, especially during the period of initial treatment when safety concerns are highest (grade of evidence: C; strength of recommendation: very strong).

Definitions:

Grades of Evidence

Each recommendation is graded on the basis of the Oxford Centre for Evidence-Based Medicine grade of evidence (A–D) system (see www.cebm.net/levels_of_evidence.asp).

Strengths of Recommendation

The strength of each recommendation, in terms of the extent to which experts agreed that the recommendation is highly appropriate and a "first-line" practice, was reached for each recommendation. Recommendation strength was rated in 4 categories:

  • Very strong (>90% agreement)
  • Strong (>70% agreement)
  • Fair (>50% agreement)
  • Weak (<50% agreement)

CLINICAL ALGORITHM(S)

The original guideline document contains a clinical algorithm for "Preparation for Managing Depression in Primary Care."

EVIDENCE SUPPORTING THE RECOMMENDATIONS

TYPE OF EVIDENCE SUPPORTING THE RECOMMENDATIONS

The type of evidence is identified and graded for each recommendation (see "Major Recommendations").

IDENTIFYING INFORMATION AND AVAILABILITY

BIBLIOGRAPHIC SOURCE(S)

ADAPTATION

Not applicable: The guideline was not adapted from another source.

DATE RELEASED

2007 Nov

GUIDELINE DEVELOPER(S)

Guidelines for Adolescent Depression in Primary Care (GLAD-PC)

SOURCE(S) OF FUNDING

Guidelines for Adolescent Depression in Primary Care (GLAD-PC)

GUIDELINE COMMITTEE

Guidelines for Adolescent Depression in Primary Care (GLAD-PC) Steering Group

COMPOSITION OF GROUP THAT AUTHORED THE GUIDELINE

Authors: Rachel A. Zuckerbrot, MD, Division of Child Psychiatry, Department of Psychiatry, Columbia University/New York State Psychiatric Institute, New York, New York; Amy H. Cheung, MD, Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada; Peter S. Jensen, MD, REACH Institute, Resource for Advancing Children's Health, New York, New York; Ruth E. K. Stein, MD, Department of Pediatrics, Albert Einstein College of Medicine, Bronx, New York; Danielle Laraque, MD, Department of Pediatrics, Mount Sinai School of Medicine, New York, New York

GLAD-PC Project Team Members: Peter S. Jensen, MD (project director, REACH Institute); Amy Cheung, MD (project coordinator, University of Toronto/Columbia University); Rachel A. Zuckerbrot, MD (project coordinator, Columbia University); Kareem Ghalib, MD (Columbia University); Anthony Levitt, MD (project consultant, University of Toronto)

GLAD-PC Steering Committee Members: Boris Birmaher, MD (Western Psychiatric Institute & Clinic, University of Pittsburgh); John Campo, MD (Ohio State University and Nationwide Children's Hospital); Greg Clarke, PhD (Center for Health Research, Kaiser Permanente); Dave Davis, MD (University of Toronto); Angela Diaz, MD (Mount Sinai School of Medicine); Allen Dietrich, MD (Dartmouth Hitchcock Medical Center); Graham Emslie, MD (University of Texas Southwestern Medical School); Bernard Ewigman, MD (Department of Family Medicine, University of Chicago); Eric Fombonne, MD (McGill University); Sherry Glied, PhD (Columbia University); Kimberly Eaton Hoagwood, PhD (Office of Mental Health, New York State/Columbia University); Charles Homer, MD (National Initiative for Children's Healthcare Quality); Danielle Laraque, MD (AAP New York Chapter 3, District II/Mount Sinai School of Medicine); Miriam Kaufman, MD (Hospital for Sick Children, University of Toronto); Kelly J. Kelleher, MD (Ohio State University); Stanley Kutcher, MD (Dalhousie Medical School); Michael Malus, MD (Department of Family Medicine, McGill University); James Perrin, MD (Massachusetts Medical School/Harvard Medical School); Harold Pincus, MD (Columbia University/New York State Psychiatric Institute); Brenda Reiss-Brennan, APRN (Intermountain Health); Diane Sacks, MD (Canadian Paediatric Society); Ruth E. K. Stein, MD (Forum for Child Health, New York Academy of Medicine, Albert Einstein College of Medicine); Bruce Waslick, MD, Baystate Health Systems, MA)

FINANCIAL DISCLOSURES/CONFLICTS OF INTEREST

Dr Cheung was on the speakers' bureau of Eli Lilly (2004-2005); Dr Jensen has received several unrestricted educational grants from Eli Lilly, McNeil, and Janssen-Ortho, is a consultant for Shire-Richwood, UCB Pharma, McNeil, and Janssen-Ortho, and is on the speakers' bureau for UCB Pharma, McNeil, and Janssen-Ortho. The other authors have indicated they have no financial relationships relevant to this article to disclose.

ENDORSER(S)

American Academy of Child and Adolescent Psychiatry - Medical Specialty Society
Canadian Academy of Child Psychiatry - Medical Specialty Society
Canadian Association for Adolescent Health - Medical Specialty Society
Canadian Paediatric Society - Medical Specialty Society
Canadian Psychiatric Association - Medical Specialty Society
College of Family Physicians of Canada - Professional Association
Depression and Bipolar Support Alliance - Disease Specific Society
Federation of Families for Children's Mental Health - Medical Specialty Society
Mental Health America - Medical Specialty Society
Mental Health Association of New York City - Professional Association
National Alliance on Mental Illness - Private Nonprofit Organization
National Association of Pediatric Nurse Practitioners - Professional Association
Society for Adolescent Medicine - Medical Specialty Society
Society for Developmental and Behavioral Pediatrics - Professional Association

GUIDELINE STATUS

This is the current release of the guideline.

GUIDELINE AVAILABILITY

Electronic copies: Available from the Pediatrics journal Web site.

Print copies: Available from Rachel A. Zuckerbrot, MD, Columbia University, Division of Child Psychiatry, Department of Psychiatry, 1051 Riverside Drive, Unit 78, New York, NY 10032. E-mail: raz1@columbia.edu.

AVAILABILITY OF COMPANION DOCUMENTS

PATIENT RESOURCES

The following is available:

Please note: This patient information is intended to provide health professionals with information to share with their patients to help them better understand their health and their diagnosed disorders. By providing access to this patient information, it is not the intention of NGC to provide specific medical advice for particular patients. Rather we urge patients and their representatives to review this material and then to consult with a licensed health professional for evaluation of treatment options suitable for them as well as for diagnosis and answers to their personal medical questions. This patient information has been derived and prepared from a guideline for health care professionals included on NGC by the authors or publishers of that original guideline. The patient information is not reviewed by NGC to establish whether or not it accurately reflects the original guideline's content.

NGC STATUS

This NGC summary was completed by ECRI Institute on May 30, 2008. The information was verified by the guideline developer on August 18, 2008.

COPYRIGHT STATEMENT

This NGC summary is based on the original guideline, which is subject to the guideline developer's copyright restrictions.

DISCLAIMER

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