Pediatric Primary Care Providers and Adolescent Depression: A Qualitative Study of Barriers to Treatment and the Effect of the Black Box Warning |
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| Institution: | 1. Department of Pediatrics, Child Health Institute, University of Washington School of Medicine, Seattle, Washington;2. Children’s Hospital and Regional Medical Center, Seattle, Washington;3. Department of Psychiatry & Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington;1. Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21205, USA;2. Division of General Internal Medicine, Johns Hopkins School of Medicine, 1830 E. Monument Street, Baltimore, MD, 21205, USA;3. Center for Drug Safety and Effectiveness, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21205, USA;1. Rollins School of Public Health, Emory University;2. Health Services Research Program, Bradley Hospital, Alpert Medical School of Brown University, and Brown Public Health Program;3. University of Maryland, School of Public Health;1. New York University Langone Medical Center, New York, and New York State Office of Mental Health, Albany;2. Center for Health Services Research on Pharmacotherapy, Chronic Disease Management, and Outcomes/Institute for Health, Rutgers University, New Brunswick, NJ;3. New York State Office of Mental Health, Albany;4. New York State Office of Mental Health and School of Public Health, State University of New York at Albany;5. National Committee for Quality Assurance, Washington, DC;6. College of Physicians and Surgeons, Columbia University, and New York State Psychiatric Institute, New York;1. Center for Innovation in Pediatric Practice, Nationwide Children''s Hospital, Columbus, Ohio;2. Division of Adolescent Medicine, Nationwide Children''s Hospital, Columbus, Ohio;3. Department of Pediatrics, College of Medicine, The Ohio State University, Columbus, Ohio;4. Kaiser Permanente Northwest Research Institute, Seattle, Washington;5. Center for Surgical Outcomes Research, Nationwide Children''s Hospital, Columbus, Ohio;6. Division of Epidemiology, College of Public Health, The Ohio State University, Columbus, Ohio |
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| Abstract: | PurposeThe recent black box warning on antidepressants has drawn attention to controversies regarding the treatment of adolescent depression in primary care settings, but little is known about how providers decide to treat depressed youth and what resources are employed.MethodsWe conducted focus groups with 35 providers and staff in nine community-based pediatric practices in rural and urban settings of western Washington State. Discussion topics included perceived barriers to the treatment of depression in youth, how providers addressed these barriers, and the impact of the recent Federal Drug Administration (FDA) black-box warning. Focus groups were audiotaped and professionally transcribed. Qualitative content analysis was conducted using Atlas ti software and differences in coding were resolved via discussion by three independent reviewers.ResultsBased on analysis of interviews, a conceptual model was developed detailing factors influencing primary care providers’ (PCP) decisions about depression treatment. The three key themes that influenced doctors’ decisions about treating depression were lack of availability of mental health resources in the community, feeling responsible for helping based on long-standing relationships with patients and families, and patient and family beliefs and preferences regarding treatment. Most of the approaches to address barriers were not systemized and were physician dependent. Most providers expressed concern about recent antidepressant warnings, but many continued to treat and none had developed new strategies for closer monitoring of youth initiating treatment with antidepressants.ConclusionThe decision of when and how PCPs decide to treat adolescent depression is strongly influenced by PCP perceptions of their role in treatment, availability of other treatment resources, and family and patient preferences and resources. Few practices have developed changes in the approach to practice needed to meet FDA black-box recommendations regarding close monitoring of response to medications. |
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