Meredith LS, Stein BD, Paddock SM. Perceived barriers to treatment for adolecent depression. Med Care. 2009;47(6):677-685
A new study suggests some teenagers with depression may not want treatment because they worry about the label attached to the disorder. In interviews with 368 teenagers with and without depression, researchers found that for those with the disorder, social labeling and worrying over their families' reaction to their disorder were some of the main perceived barriers to getting therapy. The heartbreaking statistics showed later that the teenagers who reported those obstacles were less likely than others to have started counseling or drug therapy 6 months later. The findings suggest that when a teenager is found to be depressed, providers should talk with them about any reluctance toward treatment, the researchers report in the journal Medical Care. And that discussion, the investigators add, should also involve the parents who, in this study, often did not see the same treatment barriers that their children did. In interviews, parents were less likely to cite any barriers to their children getting treatment, and when they did, they tended to point to practical concerns, like costs and difficulty with transportation. "With teenagers, treatment decisions greatly involve other parties, especially parents," lead researcher Dr. Lisa Meredith, a scientist at the RAND Corporation in Santa Monica, California, noted in a written statement. "For instance," she said, "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." Talking with both teens and parents about any reluctance toward treatment may help make teens more comfortable with therapy, Meredith and her colleagues write. It may also give parents a better idea of what their children are going through emotionally, they add. Their reluctance to therapy may also key in to some of the deeper problems the teen is facing. "Once primary care providers understand the perceived barriers that exist on both sides," Meredith said, "they are better able to work with a family to get care that feels right for a particular teenager." 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. 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.