Achieving Depression Literacy: The Adolescent Depression Knowledge Questionnaire (ADKQ).

Mental health literacy appears to be an important target for prevention and intervention efforts. However, limitations exist in this literature base, including the lack of a validated measure to assess this construct. The Adolescent Depression Knowledge Questionnaire (ADKQ) was created to assess knowledge of depression and attitudes about seeking help (i.e., depression literacy) for mental health issues before and after introduction of a universal, school-based intervention, the Adolescent Depression Awareness Program (ADAP). The ADKQ measured depression knowledge and attitudes in 8,216 high school students immediately before ADAP was implemented and 6 weeks after. The latent structure of the Knowledge section was examined with attention to measurement invariance between males and females and type of instructor, as well as pre- to post-test. Categories were developed for the open-ended questions of the Attitudes section. A one-factor (General Knowledge) latent structure was the best fit to the data. The latent structure of the ADKQ did not differ by student's gender or type of instructor, nor did it differ based on pre- or post-test. Categories for the Attitudes portion of the ADKQ were developed. Psychometric evidence supports the ADKQ as a measure to evaluate adolescent depression literacy pre- to post-test and within several groups of interest (e.g., gender, facilitator). Categories for the Attitudes section of the ADKQ will allow for easier evaluation of this measure with quantitative data.

Evaluation of guideline-concordant care for bipolar disorder among privately insured youth.

OBJECTIVE: To describe and quantify the prevalence of treatments and services for youth with bipolar disorder and to assess whether concordance with treatment guidelines is associated with inpatient hospitalization and emergency department visits. METHOD: Insurance claims of 423 privately insured youth (ages 6-18) having prescription drug coverage and diagnosed with bipolar disorder were examined from the 2000-2001 Thomson Medstat MarketScan database, a national (US) dataset. Treatments and services were examined for the 6 months following the index bipolar disorder diagnosis, defined as the first diagnosis after a diagnosis-free period of 6 months. RESULTS: The majority of youth did not receive guideline-concordant care. Only 26% (n = 109) received a mood stabilizer or antipsychotic, as recommended, within 1 month of a bipolar diagnosis. Antidepressant monotherapy, which is contraindicated in therapeutic guidelines, was observed for 33% (n = 140) of youth. Less than 40% of youth received adjunctive psychotherapy. Guideline concordance was statistically significantly related to a lower likelihood of an inpatient hospitalization or an emergency department visit. CONCLUSIONS: Although deviation from guidelines may be warranted in some cases due to individual variation and patient complexity or patient and/or family preferences, these findings suggest that evidence-based guidelines are not followed in clinical practice. Incorporation of guideline-concordant care may increase the likelihood of overall better quality of care and presage better long-term outcomes for youths diagnosed with bipolar disorder.

The effectiveness of a school-based adolescent depression education program.

In an effort to decrease the suicide rate in adolescents, many interventions have focused on school-based suicide prevention programs. Alternatively, depression education in schools might be effective in decreasing the morbidity, mortality, and stigma associated with adolescent depression. The Adolescent Depression Awareness Program (ADAP) developed a 3-hour curriculum to teach high school students about the illness of depression. The purpose of this study was to assess the effectiveness of the ADAP curriculum in improving high school students' knowledge about depression. From 2001 to 2005, 3,538 students were surveyed on their knowledge about depression before and after exposure to the ADAP curriculum. The number of students scoring 80% or higher on the assessment tool more than tripled from pretest to posttest (701 to 2,180), suggesting the effectiveness of the ADAP curriculum. Further study and replication are required to determine if improved knowledge translates into increased treatment-seeking behavior.

A survey of adolescents' knowledge about depression.

Adolescent depression and suicide are major public health concerns. Best practices for suicide prevention and education in high schools are not well understood. The Adolescent Depression Awareness Program (ADAP) was developed to address depression education as an effective means towards decreasing the morbidity and mortality associated with adolescent depression. Adolescents' baseline knowledge about depression was assessed to enhance curriculum development. The survey was administered to 5,645 high school students between 1999 and 2003. Results indicated that students had a cursory knowledge of depression facts but had gaps in knowledge about treatment and symptom identification.