Fear of Family Reaction Is Barrier to Treatment for Depressed Teens

[David Baxter PhD]

Fear of Family Reaction Is Barrier to Treatment for Depressed Teens
By Milly Dawson, Health Behavior News Service
May 26, 2009

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 reseacher 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.

Source: Meredith LS, et al. Perceived barriers to treatment for adolescent depression. Medical Care 47(6), 2009.

See also: Perceived barriers to treatment for adolescent depression.

 

[Daniel E.]

Depressed teens worry about family reaction

Depressed teens worry about family reaction: study
Jun 1, 2009

NEW YORK (Reuters Health) - Some teenagers with depression may not want treatment because they worry about the stigma attached to the disorder, a new study suggests.

In interviews with 368 teenagers with and without depression, researchers found that for those with the disorder, social stigma and worry over their families' reaction were some of the main perceived barriers to getting therapy.

What's more, the study found, teenagers who reported those obstacles were less likely than others to have started counseling or drug therapy six months later.

The findings suggest that when a teenager is found to be depressed, doctors 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 getting their child to therapy.

"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 kids 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.

"Once primary care doctors 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."

Journal article:
"Perceived Barriers to Treatment for Adolescent Depression"