Perceived barriers to treatment for adolescent depression

Although teen depression poses a widespread problem for which proven treatments exist, few depressed teens receive any care.

Why don't they undergo treatment? The answer depends whether you ask parents or the adolescents themselves, according to a study in the June issue of the journal Medical Care.

"With teenagers, treatment decisions greatly involve other parties, especially parents. For instance, teenagers often rely on adults for transportation. Doctors need a sense not just of what the teen thinks or what the parent thinks, but what both think," said Lisa Meredith, Ph.D., lead author of the new study.

The ability of their physicians to address all the perceived barriers "affects the teenager's own ability to acknowledge their depression and do something about it," said Meredith, a researcher at RAND.

Teens with untreated depression more often have social and academic problems, become parents prematurely, abuse drugs and alcohol and suffer adult depression and suicide.

For the study, researchers recruited 368 adolescent patients of diverse backgrounds receiving care in seven public or private primary care practices. Of these, half had a diagnosis of depression. One parent or guardian of each enrolled teenager also participated.

Teens and parents rated the effects of seven possible barriers: 1) cost of care, 2) what others might think, 3) problems finding or making appointments with a doctor or therapist, 4) time constraints and other responsibilities, 5) not wanting family to know about the depression (this was asked of teens only), 6) good care being unavailable and 7) just not wanting care.

Parents were significantly less likely to report barriers than teens.

For teens, concerns about stigma and relatives' reactions were among the significant issues, and those who perceived barriers were less likely to undergo therapy or take medications. Depressed teens were significantly more likely to perceive barriers to care than their non-depressed peers were.

"Adolescents do tend to go undiagnosed and untreated. They don't want to seem abnormal. They want to fit in. Yet when they deny problems, they often act out adaptively, drinking a lot and pursuing other high-risk behaviors," said Deborah Amdur, a psychiatrist with the Advanced Psychiatric Group in Orlando, Fla.

"This study has the potential to be significant if the findings reach the primary care physicians and help them understand their task in ensuring that adolescents have access to care," Amdur said. "It's not a simple one step of speaking with the teenager. They also have to coordinate care with the parent."

"Once primary care doctors understand the perceived barriers that exist on both sides, they are better able to work with a family to get care that feels right for a particular teenager," Meredith said.