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Survey: Only one-third of pediatric PCPs would prescribe antidepressants for severe symptoms

According to data collected in a cross-sectional survey, pediatric primary care providers seldom prescribe antidepressants to adolescents, regardless of depression severity.

Those PCPs who recommended antidepressants had greater knowledge of depression and access to an onsite mental health provider, suggesting training and co-management strategies could increase prescribing among this population.

To determine the effect of symptom severity on prescribing habits, researchers surveyed 58 pediatric PCPs using two vignettes — one described a depressed adolescent with moderate symptoms, and the other with severe symptoms; neither was suicidal. Depression knowledge, attitudes toward addressing psychosocial issues, demographics, practice characteristics and perceived barriers to care were also assessed.

Less than 50% of PCPs recommended an antidepressant (25% for moderate symptoms and 32% for severe), and symptom severity did not affect recommendation likelihood (OR=1.58; 95% CI, 0.8-3.11). Instead, a referral for child psychiatry was given more often for severe vs. moderate symptoms (OR=5.5; 95% CI, 2.47-12.2).

Those PCPs who recommended antidepressants had a better understanding of depression (OR=1.72; 95% CI, 1.14-2.59) and access to an onsite mental health care provider (OR=5.13; 95% CI, 1.24-21.2). PCPs who reported a higher sense of burden associated with seeing patients with mental health-related issues were less likely to recommend antidepressants (OR=0.85; 95% CI, 0.75-0.98).

"Given the national shortage of child psychiatrists, efforts to increase the number of depressed adolescents who receive guideline concordant pharmacologic care will require PCPs to increase the appropriate prescribing of such psychotropic medications to depressed adolescents," researchers wrote. "Further efforts are needed to develop and effectively disseminate interventions, such as depression-specific training through experiential learning, that can help support PCPs in their knowledge of and comfort with treating adolescent depression."

Disclosure: The researchers report no relevant financial disclosures.