Depression in Youth

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A sad-looking young woman

Centre for Addiction and Mental Health develops online tool to help build capacity

A new, first-of-its-kind online tool is summarizing best care practices for supporting youth as they manage their depression. It is also providing some peace of mind for family physician Dr. Karin Euler and her fellow clinicians at the Georgian Bay Family Health Team.

Before introducing the online tool into their group practice, Dr. Euler says she and her colleagues had an inconsistent approach to the care of their young, depressed patients.

“All of us were just doing whatever we thought was the right thing to do, not based on any evidence,” she said. “Children and youth were receiving different advice depending on who they saw. We weren’t unified in our response to how we should manage depression. Children and youth deserve the best treatment possible, and the best treatment possible is based on evidence and good clinical practice guidelines.”

The online tool developed by CAMH’s Cundill Centre for Child and Youth Depression is interactive and user-friendly. It includes an overview of depression in youth, a section on assessment along with a video simulating a virtual assessment and links to assessment tools. The online tool also provides two treatment pathways — one for mild depression and one for moderate/severe depression — and concludes with a resource section with links to other practical tools, many developed by the Cundill Centre in collaboration with youth and service providers. The full content of the tool can be reviewed in less than 20 minutes and is freely available to primary care clinicians across Canada.

The expectation is the tool will build capacity in primary care, which can help reduce waiting times for specialized care providers like CAMH, so patients with the most urgent needs can be properly supported.

“We were a bit dismayed by seeing the lack of standardization, the huge variability in what services were offered and the lack of alignment with evidence-based practices”

Dr. Euler, who practises in Collingwood, says the tool has been invaluable in allowing her family health team to streamline the care of their young, depressed patients. “It’s all there. You just click through the algorithm, and it pops up with the right questions to ask and guides you through all the decision points.” If the patient presents with mild depression, they are referred to the family health team’s mental health counsellors. If the patient presents with moderate/severe depression and requires medication in addition to psychotherapy, it guides Dr. Euler in deciding which medication to prescribe and the correct dosage. She said having the confidence to begin a young patient on medication is enormously important in a community where the wait to see a pediatric psychiatrist can be as long as six months.

Significantly, the tool allows her to give all her attention and focus to the patient in determining the extent of the presenting issues. “Before, when I had the patient in front of me, I was so busy multitasking, thinking about what resources would be available, what forms I needed, how badly off schedule I was now going to be. But now it’s all just there in front of me so that I can actually spend time connecting with the patient and trying to figure out what’s going on with the person, and not having my mental energy tied up with the logistics of making it work.”

Dr. Peter Szatmari, Director of the Cundill Centre, said the need for the tool became apparent after a CAMH study mapped the landscape of service provisions for children and youth experiencing depression and related concerns across Ontario. “We were a bit dismayed by seeing the lack of standardization, the huge variability in what services were offered and the lack of alignment with evidence-based practices,” he said.

They decided family physicians and pediatricians needed help in determining how to care for depressed youth. After a systematic review, they identified the National Institute for Health Care and Excellence (NICE) guidelines in the U.K. as the best guidelines for young people with depression. “We found these to be the most trustworthy clinical practice guidelines for the treatment of depression. But you align those NICE guidelines with what is going on in Ontario, and you realize there is a significant lack of alignment. People don’t know that best practices are out there.”

He said the pandemic has caused an upsurge in youth presenting to their family physicians, and exposed chronic stresses and strains in the youth mental health system. “We’ve seen significant increases in youth mental health issues, particularly depression,” he said. “Depression is a very significant challenge, one of the most common mental health challenges that kids experience. The rates are going up and have very serious, long-term consequences if it’s not treated adequately.”

Launched six years ago, the Cundill Centre for Child and Youth Depression is leading a global effort to reduce the burden of depression in the first two decades of life. The goal of the Centre is to accelerate the pace of research, care and knowledge exchange for better care for children and youth with depression.

“Until recently, the medical field has been slow to recognize that depression can develop in early childhood,” says Dr.  Szatmari, “Many of the available treatment options were not developed for young people, and while they work for some, for too many they do not.”

Rethinking the kind of treatments available and developing novel approaches will help young people recover more fully from depression, saving years of damage and disability, he said.