Impact of Experiential Training With Standardized Patients on Screening and Diagnosis of Adolescent Depression in Primary Care

Purpose: Primary care providers (PCPs) report inadequate training in depression care. The objective of this study was to examine the long-term impact of PCP training with standardized patients on screening and diagnosis of adolescent depression in primary care.

Methods: A retrospective review of electronic medical and billing records for adolescent (aged 12-18 years) well-visits assessed the frequency of screening and new diagnoses of depression. Twenty-five PCPs participated in training. The study included all adolescent well-visits in the 12 months before and after PCP training. Adolescents with a previous diagnosis of depression were excluded from the sample. Univariate and multivariable analyses were used to assess associations with screening. Odds ratios were used to describe the magnitude of associations.

Results: The analysis included 7,108 well-visits for adolescents (mean age 14.5 years, standard deviation 1.7 years; gender: 52% male; race: 65% white, 13% black, 22% other races; ethnicity: 25% Hispanic; insurance: 67% commercial). Depression screening rate increased significantly after training from 51% to 80% of adolescents seen at well-visits (adjusted odds ratio 40.8, 95% confidence interval 32.6-51.0, p < .0001). Although the likelihood of being screened for depression increased post-training, there was variation based on patient's insurance. A significantly greater percentage of adolescents were newly diagnosed with depression after training (2.22% vs. .89%, p < .0001).

Conclusions: PCPs who participated in experiential training using standardized patients were more likely to screen for and diagnose adolescent depression in the 12 months after training. Future studies are needed to examine the effects of PCP training on patient outcomes.