Assessment of Adolescents for Depression in the Pediatric Primary Care Setting

Lifetime depression rates rise to 14% for adolescents ages 15 to 18 from an average of less than 3% in childhood (Lewinsohn, Rohde, & Seeley, 1998). At any given point in time, 3% to 8% of adolescents face major depressive disorder (MDD), making it more common than asthma and most other chronic medical problems of this age group (Jackson, & Lurie, 2006). In addition, depressed youth are at risk for many co-morbidities, including conduct problems, personality disorders, substance abuse, obesity, interpersonal conflict, unfulfilling social relationships, and educational and occupational underachievement (Zalsman, Brent, & Weersing, 2006).

Adolescents visit their primary care provider an average of once to twice a year, and youth who have mental health issues are more likely than their peers to be high users of primary care services (Stein, Zitner, & Jensen, 2006). It is common for depressed adolescents to experience unexplained physical symptoms, such as headaches, stomachaches, and fatigue, and present to their primary care provider with recurrent somatic complaints that cannot be explained medically (Jackson & Lurie, 2006). This makes the primary care setting an appropriate venue for screening and identifying depression, initial management of depression, and a referral source for other mental health and psychiatric services. This article will review the current research regarding the screening, assessment, diagnosis, and treatment of adolescent depression in the primary care setting, early treatment options, and referral criteria.

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