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.