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Adolescent Depression: Views of Health Care Providers in a Pediatric Emergency Department

Cronholm, Peter F. MD, MSCE*†‡; Barg, Frances K. PhD, MD*‡§; Pailler, Megan E. PhD; Wintersteen, Mathew B. PhD; Diamond, Guy S. PhD; Fein, Joel A. MD, MPH‡∥

doi: 10.1097/PEC.0b013e3181ce2f85
Original Article

Objective: Pediatric emergency department (PED) providers are strategically positioned to identify adolescents with depression. Our objectives were to describe health care providers' perspectives on adolescent depression and the role of depression screening in the PED.

Methods: We conducted semistructured interviews with 41 health care providers from an urban, academic PED (including PED attending physicians and trainees, social workers, and psychiatrists). Interviews were audiotaped, transcribed, and entered into the N6 qualitative data analysis software version 6 (QSR International Pty Ltd, Cambridge, Mass) for coding and analysis. A multidisciplinary team used content analysis to identify 2 primary domains: (1) provider attitudes about adolescent depression and (2) factors associated with adolescent depression screening processes in a PED setting.

Results: The PED-based providers demonstrated a clear understanding of the clinical burden of adolescent depression but described complex individual and system-level barriers to addressing the issue. All providers recognized the high prevalence of adolescent depression and its impact on health and described adolescent depression as a moderate-to-large problem that was greatly underrecognized but applied primarily a biomedical model for treatment options. The respondents endorsed computerized screening as a useful approach. Concerns were raised universally regarding the ability of the health care system to respond to screened adolescents found to be depressed.

Conclusions: The study describes the perspectives of multiple, key stakeholders necessary for a system response to the identification, assessment, and management of adolescent depression in the PED. The PED providers were generally supportive of computerized depression screening in the PED setting but also voiced the need for system-level responses that facilitate access to quality mental health care services for adolescents.

From the *Department of Family Medicine and Community Health, †Leonard Davis Institute of Health Economics, ‡Center for Public Health Initiatives, §Department of Anthropology, and ∥Emergency Medicine, and ¶Center for Family Intervention Science, Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA.

Reprints: Peter F. Cronholm, MD, MSCE, Department of Family Medicine and Community Health, The University of Pennsylvania, 3400 Spruce St, 2 Gates Bldg, Philadelphia, PA 19104-4283 (e-mail:

This study was presented as a poster at the Pediatric Academic Societies Annual Meeting, San Francisco, CA, May 2006.

This study was supported by a grant (No. H34MC04366) from the Emergency Medical Services for Children Program, Maternal and Child Health Bureau, Health Resources and Services Administration, US Department of Health and Human Services.

© 2010 Lippincott Williams & Wilkins, Inc.