A brief motivational intervention for adolescent depression in school based health centers

Abstract

Adolescent depression is an important public health concern. Twelve percent to 62% percent of the adolescent populations have elevated depressive symptoms. Cognitive-behavioral therapy methods have proven efficacious in the treatment of adolescent depression, but are based on multiple-session lengthy interventions not conducive for use in the primary care setting. Brief interventions utilizing a directive, client-centered approach have proven efficacious in behavior change and are especially suitable for use with adolescents, given their stage of developing independence and autonomy. The specific aims of this study were to develop and test a brief, three-session motivational intervention for use in primary care settings which (1) decreases depressive symptoms and (2) increases behaviors protective against worsening depressive symptoms in adolescents. Theoretical framework. The theoretical framework, developed by the author, is based on the Caring Connection. Influenced by Peplau's theory of interpersonal relations and Gadow's philosophy embracing existential advocacy and relational narrative, in the ideal Caring Connection adolescents will feel valued as human beings, seen and understood, engaged in working toward understanding and integration of their experience, and involved in creation of co-authored solutions which give hope for their future life story. Methods. This is a pretest-posttest study of 22 mildly depressed female students, ages 14–17, recruited through two school based health centers, in which participants received a three-session motivational intervention. Assessment of depressive symptoms and coping behavior were made at baseline and four weeks post-intervention. Findings. Outcomes of this study were significant for decreased symptoms of depression, indicated a positive change in coping behaviors, and provided information which will enhance further studies of this intervention. Utilization of this intervention in primary care settings allows the practitioner to have a simple tool to address concerns related to depressive symptoms that can be utilized in a 15 to 30 minute office visit. Engagement with the adolescent opens the opportunity for identifying depressive symptoms, relating concerns, and assisting the adolescent to construct meaningful goals for positive changes in coping behaviors.