CURRENT PROJECTS

Guide Lines for Adolescent Depression in Primary Care (GLAD-PC)

REACH Staff

Project Director 

Peter Jensen, M.D.

Co-Directors: 

Amy Cheung, M.D.

Anthony Levitt, M.D.

Rachel Zuckerbrot, M.D.

Partners

GLAD-PC Steering Committee

Project Description

Rationale

Depression is a common illness and is the leading cause of disability worldwide.  This disorder frequently begins in adolescence and it is under-recognized and under-treated in North America.  Because of the shortage of mental health professionals, only a small percentage of these adolescents are treated by mental health professionals.  Therefore, the primary care clinics have become the ‘de Facto’ mental health clinics for this population even though most primary care clinicians feel inadequately trained for the management of this disorder.  Although there are several management guidelines developed for the specialty care setting, it is clear that significant practice and clinician differences exist between the primary and specialty care settings that do not allow a simple transfer of guidelines from one setting to another.  Up until now, there has been little research--based evidence regarding the management of depression in adolescents in the primary care setting and no available clinical guidelines.  Given the lack of research evidence, expert opinion and a synthesis of all available research can be of valuable assistance to primary care clinicians in the diagnosis and treatment of depression in adolescents.

Purpose

The purpose of GLAD-PC is to develop clinical guidelines for the management of adolescent depression in primary care.  The guidelines address issues regarding the screening, diagnosis and treatment of depression in adolescents aged 10-21.   

Target Audience

GLAD-PC is intended for dissemination to primary care providers in the US and Canada which include clinicians in Family Medicine, Pediatrics, Nursing and Internal Medicine.  These guidelines may also be helpful to allied health professionals who care for adolescents.  Recommendations from these guidelines on organizational barriers may also be of interest to health care policy makers and administrators.

Target Population

The target population addressed in these guidelines are adolescents aged 10-21 with Major Depressive Disorder and/or Dysthymia.  For the purposes of the guideline, we have excluded those with the diagnosis of Bipolar Affective Disorder given the significant differences in the treatment between these disorders.  However, many patients with Bipolar Affective Disorder present initially with depressive symptoms, so these diagnostic issues are discussed in the guidelines as well. 

Recommendations
The final product of this project are recommendations for the management of adolescent depression addressing clinical, organizational and systemic barriers.  The recommendations are published in Pediatrics 2007, Nov,120(5):e1299-e1326.  In addition, a management toolkit is available for download..

Dissemination

A major component of this project is to develop effective methods for disseminating information to clinicians.  Therefore, to facilitate eventual dissemination, clinical policy makers are encouraged to participate in guideline testing and toolkit application , as well as guideline dissemination strategies.     

Links

GLAD-PC Methods

GLAD-PC Conference Summary:  July 2004

GLAD-PC Toolkit

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