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首页> 外文期刊>Child and adolescent psychiatric clinics of North America >Primary Care Management of Child & Adolescent Depressive Disorders
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Primary Care Management of Child & Adolescent Depressive Disorders

机译：儿童和青少年抑郁症的初级保健管理

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The task of preparing primary care providers to play an effective role in the management of pediatric depressive disorders is not small. The AAP has acknowledged 7 that it represents systemic change that will take time and involve transformational changes in pediatric primary care practice, requiring new knowledge and skills, payment structures, collaborative relationships, office systems, and resources. Less overtly acknowledged is that this will involve complementary changes in child mental health practice. 6 Making these changes is a public health imperative driven by the solid data on the prevalence of adolescent depressive disorders, its risks, and the existence of effective treatments that reach few affected youth. There is now enough knowledge about first steps in treatment, at least for adolescents, and about how to house them in primary care practice to allow dedicated primary care practices, supported by the available tools, to take on the challenge. Pediatric primary care providers have the potential to play powerful roles in reducing the burden of depression in further areas, outside the scope of this paper. We have mentioned the potential for using the longitudinal and early established relationship with the primary care clinician to identify and intervene early with conditions that are risk factors for later depressive disorders. In addition, primary care clinicians often see new mothers more than any other professional during the first year of a child's life. The data tell us that up to 12% of these mothers will be afflicted with postpartum depression, 72 usually unidentified and untreated, a current and long-term risk for their children. It is important, however, to remember that this move to dissemination is somewhat in advance of the child- and adolescent-focused research. Even in the limited existing research, there are some flags that the clinical outcomes in pediatric primary care populations could differ from those in adult primary care settings and those in pediatric research settings. 59 There is work to be done to adapt the adult collaborative care models to the realities of clinical practice with youth, both in primary care and in specialty mental health care. These realities include working collaboratively with parents, an activity that is strongly supported both by common sense and the research literature, but poorly supported by existing funding mechanisms and the structure of care. Nor is there solid financial support for collaboration with the many other systems of care with which children and adolescents are involved. Treatment of parental mental health conditions, not captured in classic, adult-oriented models for collaborative care, can be a powerful intervention for pediatric mental health conditions, including depression. In addition, vulnerabilities and disorders are in evolution in childhood and adolescence: Evaluation of the full public health impact of intervention needs the long view. Finally, there are no data on how primary care clinicians will actually use the newly developed tools and on what impact any such changes in practice will have on the likelihood that depressed youth will receive treatment, on the types and adequacy of treatment provided and on clinical or cost outcomes. Dissemination must be accompanied by evaluation.
机译：准备初级保健提供者在小儿抑郁症的治疗中发挥有效作用的任务并不小。 AAP已确认7，它代表着系统的变革，需要时间，并且涉及儿科初级保健实践的变革性变革，需要新的知识和技能，支付结构，协作关系，办公系统和资源。不太明显的是，这将涉及儿童心理健康实践的补充变化。 6做出这些改变是一项公共卫生的当务之急，其依据是有关青少年抑郁症患病率，危险性以及有效治疗方法的可靠数据，这些方法很少影响到受影响的青年。现在已经有了足够的知识，至少对于青少年而言，这是治疗的第一步，以及如何将其容纳在初级保健实践中，以便在可用工具的支持下进行专门的初级保健实践以应对挑战。儿科初级保健提供者可能在减轻其他地区抑郁症负担方面发挥强大作用，这超出了本文的范围。我们已经提到了利用与初级保健临床医生的纵向关系和早期建立的关系来识别和早期干预作为潜在的抑郁症危险因素的疾病的潜力。此外，初级保健临床医生在孩子生命的第一年中经常会比其他专业人员看到新妈妈更多。数据告诉我们，这些母亲中多达12％的人会遭受产后抑郁症困扰，其中72名通常未被鉴定和未得到治疗，这对他们的孩子来说是当前和长期的风险。但是，重要的是要记住，这种传播方式在以儿童和青少年为重点的研究之前已经有所发展。即使在有限的现有研究中，也有一些标志表明，儿科初级保健人群的临床结局可能与成人初级保健环境和儿科研究环境的临床结果有所不同。 59.在初级保健和特殊精神保健中，都需要开展工作以使成人协作医疗模式适应青年临床实践的现实。这些现实包括与父母的合作，这项活动在常识和研究文献的大力支持下，但在现有的资助机制和护理结构的支持下却很少。对于与儿童和青少年参与的许多其他护理系统的合作，也没有坚实的财务支持。父母心理健康状况的治疗（不是针对成人的经典协作医疗模式中可以捕获的）可能是对儿童心理健康状况（包括抑郁症）的有力干预。此外，脆弱性和疾病在儿童和青少年时期正在演变：对干预措施对整个公共健康影响的评估需要长远的眼光。最后，没有数据说明初级保健临床医生将如何实际使用新开发的工具，以及实践中的任何此类变化将对抑郁青年获得治疗的可能性，所提供治疗的类型和充分性以及临床上产生何种影响。或成本结果。传播必须伴随评估。

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