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Depression Among African American Adolescents - Changing Policy to Improve Care

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					   Depression among
    African American
      Adolescents:

Changing Policy to Improve Care
Background
 ~ 9% of adolescents aged 12 to 17
  (approximately 2.2 million adolescents) had
  experienced at least one MDE during the past
  year


 > 70 percent of children and adolescents
  with depressive disorders or other serious
  mood disorders do not receive appropriate
  diagnosis and treatment
 Current research data vary with respect to
  which ethnic groups are impacted the most

  – Some research indicates that depression is highest
    among American Indian adolescents


  – Other data indicate that depression among urban
    African American adolescents is growing, often
    masked, and significantly higher than for other
    adolescents
 Despite incongruent prevalence rates,
  diagnostic and treatment disparities are evident

  – African American adolescents are 1.8 times more
    likely to be diagnosed with schizophrenia and about
    half as likely to be diagnosed with an affective
    disorder than their White counterparts


  – In 2004, 28.9 % of Black youth with a MDE received
    treatment for depression, compared with 44.9 % of
    Caucasian youth and 36.8 % of Hispanic youth
Significance
 Adolescent depression is a serious public health
  concern as it relates to recurrent depression in
  adulthood, suicide, and other medical and
  psychological comorbidities

 Suicide is now the third leading cause of death
  among African Americans between the ages of
  15 and 24
 MDD is a diagnosable and treatable condition,
  accounting for greater morbidity, mortality, and
  financial costs than any other psychiatric
  disorder

 Depression has been correlated with numerous
  adverse health and behavioral outcomes such
  as:
  –   Substance abuse
  –   Increased STI/HIV risk-related behaviors
  –   Violence
  –   Poor School Performance
   Risk Factors for Adolescent Depressive
                  Disorders
 Biomedical
  –   Chronic illness (e.g., diabetes)
  –   Female sex
  –   Hormonal changes during puberty
  –   Parental depression or family history of depression
  –   Presence of specific serotonin-transporter gene variants
  –   Use of certain medications (e.g., isotretinoin [Accutane])
 Psychosocial
  – Childhood neglect or abuse (physical, emotional, or
    sexual)
  – General stressors including socioeconomic deprivations
  – Loss of a loved one, parent, or romantic relationship
   Risk Factors for Adolescent Depressive
                  Disorders
 Other
  – Anxiety disorder
  – Attention-deficit/hyperactivity, conduct, or
    learning disorders
  – Cigarette smoking
  – History of depression
Is Depression a “Silent Epidemic”
     within this Population?
 The lack of clarity regarding prevalence rates
  has severe implications for depression
  assessment, diagnosis, treatment, and
  research, as rates may lead to the
  misconception that the disorder is not a
  major concern

 Lower prevalence rates may be indicative of
  patient and/or provider level factors that
  impact accurate assessment, diagnosis, and
  treatment
 What Patient and Provider Factors
    Account for Disparities in
Depression Assessment, Diagnosis,
  and Treatment among African
     American adolescents?
           Patient Level Variables
 Attitudes/stigma towards mental health care

 Cultural dynamics traditional ways of managing
  distress
   – Research shows that African American youth are
     less likely to divulge suicidal ideation
   – Emphasis on spirituality

 Use of/access to specialty mental health services
  – African American youth are more likely to access
    EDs and primary care for MH concerns
             Patient Level Variables

 Trust and comfort with providers
   – Including previous experiences with MHPs

 Ethnic, gender, and age differences in symptom
  expression and manifestation (i.e. irritable mood,
  somatization)

 Other sociodemographic factors (i.e. income,
  household status, exposure to violence)
           Provider Level Variables
 Lack of adequate training in child and adolescent
  mental health

 Personal biases
  – Castigatory services vs. treatment-oriented, ameliorative
    services


 Cultural competence and sensitivity
  – Views of internalizing vs. externalizing behaviors
            Provider Level Variables

 Decreased use of systematic depression
  identification methods

  – Some heavily depend on clinical instruments for
    diagnosis
  – Contextual data must be part of the
    comprehensive appraisal
  – Triangulating methods

 Inadequate number of PMH professionals
Areas for Future Policy
       Changes
 Depression screening and management are now
  considered to be an essential function of the
  primary care setting for adults, yet no definitive
  recommendations have been made in support of
  adolescent depression screening in primary care

  – Given the severity of depression within this population,
    “trigger” questions should be asked during ED, well
    visits, and visits for directed services

 Develop and standardize school-based mental
  health programs

  – Preventive strategies in addition to on/off site
    comprehensive mental health services
 Coverage of school-based mental health
  services by health insurers, and school billing
  of Medicaid for school-based mental health
  services

 Develop community-based programs that
  focus on building strength and resilience,
  and include the families
  – Community programs also have the potential to
    capture youth who are out of school (i.e.
    truancy, “drop-outs”, graduates, etc.)
What Can Nurses Do?
 Integrate basic MH services in NMHCs!!!

 Educate policymakers about adolescent mental
  health and disparities in care

 Partner with local schools and other institutions to
  develop and implement MH programs

 Provide community mental health education to help
  reduce stigma and improve knowledge of mental
  health services

 Advocate for adequate training in child and
  adolescent mental health for MHPs
 Contact Information

      Mrs. Brawner
brawnerb@nursing.upenn.edu

         Dr. Waite
     rlw26@drexel.edu

				
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