Jan 15, 2010
Published In: Medical Care, v. 47, no. 6, June 2009, p. 677-685
Posted on RAND.org on May 31, 2009
BACKGROUND and OBJECTIVE: Adolescent depression is common, disabling, and is associated with academic, social, behavioral, and health consequences. Despite the availability of evidence-based depression care, few teens receive it, even when recognized by primary care clinicians. Perceived barriers such as teen worry about what others think or parent concerns about cost and access to care may contribute to low rates of care. The authors sought to better understand perceived barriers and their impact on service use. DESIGN: After completing an eligibility and diagnostic telephone interview, all depressed teens and a matched sample of nondepressed teens recruited from 7 primary care practices were enrolled and completed telephone interviews at baseline and 6 months (August 2005-September 2006). PARTICIPANTS: Three hundred sixty-eight adolescent patients aged 13 to 17 (184 depressed and 184 nondepressed) and 338 of their parents. MEASURES: Perceived barriers to depression care and use of services for depression (psychotherapy and antidepressant medication). RESULTS: Teens with depression were significantly more likely to perceive barriers to care compared with nondepressed teens. Parents were less likely to report barriers than their teens; perceived stigma and concern about family member response were among the significant teen barriers. Teen perceived barriers scores were negatively associated with any use of antidepressants (P < 0.01), use of antidepressants for at least 1 month (P < 0.001), and any psychotherapy or antidepressant use (P < 0.05) at 6 months. CONCLUSIONS: To improve treatment for adolescent depression, interventions should address both teen and parent perceived barriers and primary care clinicians should elicit information from both adolescents and their parents.