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Workshop on  the  Identification,  Diagnosis  and  Treatment  of   Adolescent  Depression     Organizers:  

Pan American  Health  Organization  (PAHO):     Dr.  Jorge  Rodríguez,  PAHO  –Washington     Lic.  Ana  Cecilia  Escobar:  PAHO  –  Guatemala     WHO/PAHO  Collaborative  Centre  Dalhousie,  Canada:   Dr.  Stan  Kutcher   Dr.  Iliana  García-­‐Ortega    

Location:  Guatemala  City,  Guatemala.     Date:  23–  25  January  2013  

Background:     Depression   is   projected   to   become   the   leading   cause   of   disability   and   the   second   leading   contributor   to   the   global   burden   of   disease   by   the   year   2020.   Depression   commonly   has   its   onset  in  adolescence  –  early  adulthood  and  it  affects  6-­‐8%  of  young  people.       Youth   onset   of   depression   usually   develops   into   a   chronic   condition   with   substantial   morbidity,   poor   economic/   vocational/   interpersonal   outcomes   and   increased   mortality.   Depression   also   increases   risk   for   a   variety   of   other   illnesses,   (such   as   diabetes,   heart   disease)   and   early   mortality  through  suicide.      Early  identification  and  effective  treatment  of  depression  in  young   people,  provided  in  primary  health  care,  can  decrease  short-­‐term  morbidity  and  improve  long-­‐ term  outcomes,  including  decreased  mortality  due  to  suicide.    

“Identification,   Diagnosis   and   Treatment   of   Adolescent   Depression,   A   Package   for   Primary   Health   Care   Providers”   is   an   evidence   based   educational   program,   designed   to   enhance   the   knowledge   of   primary   health   care   providers   to   better   identify,   assess,   diagnose   and   treat   adolescent  depression.    This  educational  program  was  extensively  field-­‐tested  and  it  has  been   used  in  Canada  on  a  web-­‐based  format  and  it  is  currently  accredited  as  a  Continuing  Medical   Education   program   for   primary   health   care   providers   by   the   College   of   Family   Physicians   of   Canada.            

The program  has  been  translated  into  Spanish  and  contextualized  for  use  in  Latin  America  and   is   a   part   of   the   ongoing   collaborative   work   between   WHO/PAHO   and   Collaborative   Centre   at   Dalhousie  University.       The   present   workshop   conducted   in   Guatemala   city   is   the   result   of   previous   a   workshop   in   Panama   City;   where   the   above   mentioned   educational   program   was   introduced   to   government   mental  health  decision  makers,  key  mental  health  and  primary  care  providers  from  six  countries   in   Central   America   as   part   of   ongoing   collaborative   work   between   PAHO   and   Collaborative   Centre  in  Dalhousie  University.     The  objectives  of  the  workshop:  

1. To   increase  awareness  and   knowledge   regarding   Adolescent   Depression   and   the   benefits  of  early  intervention  among  primary  health  care  providers  in  Guatemala.     2. To   train   a   group   of   trainers   to   identify,   diagnose   and   treat   adolescent   depression   utilizing  evidence  based  interventions.     3. Disseminate  and  implement  the  program  throughout  Guatemala.  


A total  of  29  people  attend  the  workshop:  

– 2, Primary  care  doctors   – 1,  Nurse  practitioners   – 26,   Psychologists   (3   of   them   working   in   remote-­‐   rural   areas:   Alta   Verapaz,   Escuintla  and  Jutiapa,  the  rest  working  in  Guatemala  City)     Process:     The   workshop   was   conducted   over   2   days.   The   work   sessions   started   at   8:30am   and   went   to   4:00pm  daily.  

Day   1   -­‐   Introduction   and   opening   sessions   took   place   during   the   morning   as   well   as   a   pre-­‐ training  evaluation,  to  measure  a  basal  knowledge  regarding  adolescent  depression.  During  the   afternoon  the  first  part  of  the  educational  session  was  covered.    

Day 2   –   Was   a   full   day   of   educational   session,   at   the   end   of   the   training   an   evaluation   was   conducted  to  measure  knowledge  acquisition.    

Day  3  -­‐  On  day  three  workshop  organizers  visited  a  community  Health  Centre.  They  then  met  at   the  offices  of  the  Ministry  of  Health  to  discuss  further  steps  and  future  plans  to  continue  the   collaborative  work.  

Results  of  the  evaluation:     A   knowledge   assessment   for   program   evaluation   purposes   was   conducted   on   day   1   before   training   and   on   day   2   after   the   training   process   in   order   to   measure   the   knowledge   acquisition.   The   surveys   were   anonymous.   At   the   end   of   the   second   day   we   collected   27   surveys   that   were   able  to  be  matched  and  conducted  a  statistical  analysis.  

• •

Pre Training  Score    =    58%  Correct     Post  Training  Score  =  89%  Correct    

A   Paired   samples   t-­‐test   was   used   to   determine   whether   a   significant   difference   occurred   between  pre  and  post  test  scores.   Results  indicate  that  the  post-­‐training  mean  for  correct  survey  responses  (M=17.8:  SD  1.39)  was   significantly  greater  than  the  pre-­‐training  mean  correct  scores  (M=  10.90:  SD  1.66),  t(28)  =  8.27,   p<.0001     These  results  suggest  that  participation  in  the  training  is  associated  with  significant  increases  in   knowledge  regarding  adolescent  depression.  

Comments from  participants:  

“Thank   you   for   an   excellent   workshop,   we   were   provided   with   excellent   and   in-­‐depth   information”  

“Congratulations  and  thank  you  for  the  interest  towards  the  improvement  of  mental  health  in   Guatemala;  we  need  more  of  these  initiatives”  

“Excellent  workshop,  I  would  like  to  see  further  work  within  the  communities  in  Guatemala”  

“The   facilitators   were   great   as   well   as   the   methodology   used,   we   hope   you   will   be   back   to   Guatemala,  to  keep  working”.  

Conclusions  and  next  steps:     The  workshop  was  highly  successful  and  met  all  initial  objectives.  

We   are   hopeful   that   the   majority   of   the   participants   will   be   able   to   begin   to   implement   the   program   by   training   other   primary   health   care   provides   on   the   identification,   diagnosis   and   treatment   of   adolescent   depression   in   the   near   future;   with   the   goal   of   improving   the   early   identification,   diagnosis   and   evidence   based   treatment   of   adolescents   with   depression   who   attend  the  primary  health  care  in  Guatemala.  

Although the  value  of  the  medical  education  approach  in  addressing  health  care  needs  of   patients  is  well  established,  the  application  of  this  program  in  Guatemala  provides  a  unique   opportunity  to  determine  its  utility,  feasibility  and  potential  clinical  value  in  the  primary  care   setting.    As  future  steps  of  this  positive  collaboration  between  PAHO  and  Collaborative  Centre   at  Dalhousie  University,  a  research  project  is  being  organized  to  determine  if  this  training   program  has  clinical  utility  in  the  community  based  primary  care  and  if  this  intervention  can   result  in  appropriate  delivery  of  best  evidence  based  care.  


Guatemala mdd training report 2013