Primary care pediatricians' roles and perceived responsibilities in the identification and management of depression in children and adolescents

Objective.-To describe primary care pediatricians' 1) approach to the ident ification and management of childhood and adolescent depression and 2) perc eption of their skills, responsibilities, and barriers in recognizing and m anaging depression in children and adolescents. Design and Methods.-National cross-sectional survey of randomly selected pr imary care pediatricians that assessed the management of recalled last case of child or adolescent depression, attitudes, limitations to care from bar riers and skills, and willingness to implement new educational or intervent ion strategies to improve care. Results.-There were 280 completed surveys about child and adolescent depres sion (63% response rate). Pediatricians overwhelmingly reported it was thei r responsibility to recognize depression in both children and adolescents ( 90%) but were unlikely to feel responsible for treating children or adolesc ents (26%-27%). Those with most of their practice in capitated managed care were less likely to feel responsible for recognizing depression in either children or adolescents. Forty-six percent of pediatricians lacked confiden ce in their skills to recognize depression in children, and few of them (10 %-14%) had confidence in their skills in different aspects of treatment wit h children or adolescents. Diagnostic, assessment, and management details f or their last recalled case of depression in a child or adolescent were pro vided by 248 of these pediatricians. In addition to referring 78%-79% of th e cases to mental health care professionals, 77% of pediatricians provided a wide range of brief interventions. Only 19%-20% prescribed medication. Ma jor factors cited that limited their diagnosis or management were time (56% -68%) and training or knowledge of issues (38%-56%). Fewer pediatricians no ted limitations due to insurer or financial issues (8%-39%) or patient issu es (19%-31%). The 35% of pediatricians who were motivated to change their r ecognition and management of suspected depression were significantly more i nterested in implementing in the future a variety of new strategies to impr ove care. Conclusion.-Primary care pediatricians felt responsible for recognizing but not for treating child and adolescent depression. Although the lack of con fidence and lack of knowledge and/or skills and time issues are major barri ers that limit pediatricians in their treatment of childhood and adolescent depression, pediatricians varied in their readiness to change, with some b eing more willing to implement new strategies to care for depression. Educa tional and practice interventions need to focus on how to assist all pediat ricians in diagnosis and to prepare these motivated pediatricians to manage depression in primary care settings.