{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T21:05:38Z","timestamp":1790888738884,"version":"4.1.0"},"reference-count":50,"publisher":"American Academy of Pediatrics (AAP)","issue":"5","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,5,1]]},"abstract":"\n BACKGROUND AND OBJECTIVES<\/jats:title>\n Primary care pediatricians (PCP) are often called on to manage child and adolescent anxiety and depression. The objective of this study was to describe PCP care practices around prescription of selective serotonin reuptake inhibitors (SSRI) for patients with anxiety and\/or depression by using medical record review.<\/jats:p>\n <\/jats:sec>\n \n METHODS<\/jats:title>\n We identified 1685 patients who had at least 1 visit with a diagnosis of anxiety and\/or depression in a large primary care network and were prescribed an SSRI by a network PCP. We randomly selected 110 for chart review. We reviewed the visit when the SSRI was first prescribed (medication visit), immediately previous visit, and immediately subsequent visit. We abstracted rationale for prescribing medication, subspecialist involvement, referral for psychotherapy, and medication monitoring practices.<\/jats:p>\n <\/jats:sec>\n \n RESULTS<\/jats:title>\n At the medication visit, in 82% (n = 90) of cases, PCPs documented reasons for starting an SSRI, most commonly clinical change (57%, n = 63). Thirty percent (n = 33) of patients had documented involvement of developmental-behavioral pediatrics or psychiatry subspecialists at 1 of the 3 visits reviewed. Thirty-three percent (n = 37) were referred to unspecified psychotherapy; 4% (n = 4) were referred specifically for cognitive behavioral therapy. Of 69 patients with a subsequent visit, 48% (n = 33) had documentation of monitoring for side effects.<\/jats:p>\n <\/jats:sec>\n \n CONCLUSIONS<\/jats:title>\n When prescribing SSRIs for children with anxiety and\/or depression, PCPs in this network documented appropriate indications for starting medication and prescribed without subspecialist involvement. Continuing medical education for PCPs who care for children with these conditions should include information about evidence-based psychotherapy and strategies for monitoring potential side effects.<\/jats:p>\n <\/jats:sec>","DOI":"10.1542\/peds.2022-058846","type":"journal-article","created":{"date-parts":[[2023,4,19]],"date-time":"2023-04-19T13:09:12Z","timestamp":1681909752000},"source":"Crossref","is-referenced-by-count":18,"title":["Anxiety and Depression Treatment in Primary Care Pediatrics"],"prefix":"10.1542","volume":"151","author":[{"given":"Talia R.","family":"Lester","sequence":"first","affiliation":[{"name":"aDivision of Developmental Behavioral Pediatrics, Department of Pediatrics"},{"name":"bStanford School of Medicine, Palo Alto, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jessica E.","family":"Herrmann","sequence":"additional","affiliation":[{"name":"bStanford School of Medicine, Palo Alto, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yair","family":"Bannett","sequence":"additional","affiliation":[{"name":"aDivision of Developmental Behavioral Pediatrics, Department of Pediatrics"},{"name":"bStanford School of Medicine, Palo Alto, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rebecca M.","family":"Gardner","sequence":"additional","affiliation":[{"name":"bStanford School of Medicine, Palo Alto, California"},{"name":"cQuantitative Science Unit, Department of Medicine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Heidi M.","family":"Feldman","sequence":"additional","affiliation":[{"name":"aDivision of Developmental Behavioral Pediatrics, Department of Pediatrics"},{"name":"bStanford School of Medicine, Palo Alto, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lynne C.","family":"Huffman","sequence":"additional","affiliation":[{"name":"aDivision of Developmental Behavioral Pediatrics, Department of Pediatrics"},{"name":"bStanford School of Medicine, Palo Alto, California"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"417","published-online":{"date-parts":[[2023,4,17]]},"reference":[{"issue":"6","key":"2023111014132418300_B1","doi-asserted-by":"crossref","first-page":"e20161878","DOI":"10.1542\/peds.2016-1878","article-title":"National trends in the prevalence and treatment of depression in adolescents and young adults","volume":"138","author":"Mojtabai","year":"2016","journal-title":"Pediatrics"},{"issue":"11","key":"2023111014132418300_B2","doi-asserted-by":"crossref","first-page":"1142","DOI":"10.1001\/jamapediatrics.2021.2482","article-title":"Global prevalence of depressive and anxiety symptoms in children and adolescents during COVID-19: a meta-analysis","volume":"175","author":"Racine","year":"2021","journal-title":"JAMA Pediatr"},{"issue":"7","key":"2023111014132418300_B3","doi-asserted-by":"crossref","first-page":"3432","DOI":"10.3390\/ijerph18073432","article-title":"Mental health of children and adolescents amidst COVID-19 and past pandemics: a rapid systematic review","volume":"18","author":"Meherali","year":"2021","journal-title":"Int J Environ Res Public Health"},{"issue":"16","key":"2023111014132418300_B4","doi-asserted-by":"crossref","first-page":"5757","DOI":"10.3390\/ijerph17165757","article-title":"Children\u2019s anxiety and factors related to the COVID-19 pandemic: an exploratory study using the children\u2019s anxiety questionnaire and the numerical rating scale","volume":"17","author":"Garcia de Avila","year":"2020","journal-title":"Int J Environ Res Public Health"},{"issue":"22","key":"2023111014132418300_B5","doi-asserted-by":"crossref","first-page":"8479","DOI":"10.3390\/ijerph17228479","article-title":"Exploring the impact of COVID-19 on mental health outcomes in children and adolescents: a systematic review","volume":"17","author":"Nearchou","year":"2020","journal-title":"Int J Environ Res Public Health"},{"issue":"10312","key":"2023111014132418300_B6","doi-asserted-by":"crossref","first-page":"1700","DOI":"10.1016\/S0140-6736(21)02143-7","article-title":"Global prevalence and burden of depressive and anxiety disorders in 204 countries and territories in 2020 due to the COVID-19 pandemic","volume":"398","author":"Santomauro","year":"2021","journal-title":"Lancet"},{"key":"2023111014132418300_B7","doi-asserted-by":"crossref","DOI":"10.15585\/mmwr.su7103a3","article-title":"Mental health, suicidality, and connectedness among high school students during the COVID-19 pandemic \u2014 adolescent behaviors and experiences survey, United States, January\u2013June 2021","volume":"71","author":"Jones","year":"2022","journal-title":"MMWR Suppl"},{"key":"2023111014132418300_B8","doi-asserted-by":"crossref","first-page":"e173","DOI":"10.1017\/S2045796020000888","article-title":"Increase in prevalence of current mental disorders in the context of COVID-19: analysis of repeated nationwide cross-sectional surveys","volume":"29","author":"Winkler","year":"2020","journal-title":"Epidemiol Psychiatr Sci"},{"key":"2023111014132418300_B9","unstructured":"AAP-AACAP-CHA declaration of a national emergency in child and adolescent mental health. Available at: https:\/\/www-aap-org.laneproxy.stanford.edu\/en\/advocacy\/child-and-adolescent-healthy-mental-development\/aap-aacap-cha-declaration-of-a-national-emergency-in-child-and-adolescent-mental-health\/. Accessed June 15, 2022"},{"issue":"1","key":"2023111014132418300_B10","doi-asserted-by":"crossref","first-page":"97","DOI":"10.1016\/j.pcl.2015.08.005","article-title":"Integrating children\u2019s mental health into primary care","volume":"63","author":"Wissow","year":"2016","journal-title":"Pediatr Clin North Am"},{"issue":"5","key":"2023111014132418300_B11","doi-asserted-by":"crossref","first-page":"e1178","DOI":"10.1542\/peds.2015-0807","article-title":"Outpatient visits and medication prescribing for US children with mental health conditions","volume":"136","author":"Anderson","year":"2015","journal-title":"Pediatrics"},{"issue":"9","key":"2023111014132418300_B12","doi-asserted-by":"crossref","first-page":"1548","DOI":"10.1176\/appi.ajp.159.9.1548","article-title":"Unmet need for mental health care among U.S. children: variation by ethnicity and insurance status","volume":"159","author":"Kataoka","year":"2002","journal-title":"Am J Psychiatry"},{"issue":"6","key":"2023111014132418300_B13","doi-asserted-by":"crossref","first-page":"e20191576","DOI":"10.1542\/peds.2019-1576","article-title":"Growth and distribution of child psychiatrists in the United States: 2007-2016","volume":"144","author":"McBain","year":"2019","journal-title":"Pediatrics"},{"issue":"5","key":"2023111014132418300_B14","doi-asserted-by":"crossref","first-page":"950","DOI":"10.1038\/s41390-020-01349-7","article-title":"Primary care pediatrician perceptions towards mental health within the primary care setting","volume":"90","author":"Imfeld","year":"2021","journal-title":"Pediatr Res"},{"issue":"8","key":"2023111014132418300_B15","doi-asserted-by":"crossref","first-page":"605","DOI":"10.1097\/DBP.0000000000000821","article-title":"Pediatric anxiety in practice: a knowledge and needs assessment of pediatricians and nurses","volume":"41","author":"Rozenman","year":"2020","journal-title":"J Dev Behav Pediatr"},{"issue":"1","key":"2023111014132418300_B16","doi-asserted-by":"crossref","first-page":"15","DOI":"10.1016\/j.cppeds.2016.11.009","article-title":"Antidepressant prescribing by pediatricians: a mixed-methods analysis","volume":"47","author":"Tulisiak","year":"2017","journal-title":"Curr Probl Pediatr Adolesc Health Care"},{"issue":"651","key":"2023111014132418300_B17","doi-asserted-by":"crossref","first-page":"e693","DOI":"10.3399\/bjgp16X687061","article-title":"Barriers to managing child and adolescent mental health problems: a systematic review of primary care practitioners\u2019 perceptions","volume":"66","author":"O\u2019Brien","year":"2016","journal-title":"Br J Gen Pract"},{"issue":"6","key":"2023111014132418300_B18","doi-asserted-by":"crossref","first-page":"613","DOI":"10.1016\/j.acap.2015.08.006","article-title":"Barriers to the identification and anagement of psychosocial problems: changes from 2004 to 2013","volume":"15","author":"Horwitz","year":"2015","journal-title":"Acad Pediatr"},{"issue":"6","key":"2023111014132418300_B19","doi-asserted-by":"crossref","first-page":"E82","DOI":"10.1542\/peds.105.6.e82","article-title":"Pediatrician and family physician prescription of selective serotonin reuptake inhibitors","volume":"105","author":"Rushton","year":"2000","journal-title":"Pediatrics"},{"issue":"5","key":"2023111014132418300_B20","doi-asserted-by":"crossref","first-page":"e20152974","DOI":"10.1542\/peds.2015-2974","article-title":"Variations in mental health diagnosis and prescribing across pediatric primary care practices","volume":"137","author":"Mayne","year":"2016","journal-title":"Pediatrics"},{"key":"2023111014132418300_B21","doi-asserted-by":"crossref","first-page":"794722","DOI":"10.3389\/fped.2022.794722","article-title":"Medication management of anxiety and depression by primary care pediatrics providers: a retrospective electronic health record study","volume":"10","author":"Lester","year":"2022","journal-title":"Front Pediatr"},{"issue":"1","key":"2023111014132418300_B22","doi-asserted-by":"crossref","first-page":"16m11415","DOI":"10.4088\/JCP.16m11415","article-title":"Treating pediatric anxiety: Initial use of SSRIs and other anti-anxiety prescription medications","volume":"79","author":"Bushnell","year":"2018","journal-title":"J Clin Psychiatry"},{"issue":"6","key":"2023111014132418300_B23","doi-asserted-by":"crossref","first-page":"e2021051107","DOI":"10.1542\/peds.2021-051107","article-title":"Improving follow-up for adolescents with depression in primary care","volume":"149","author":"Garbutt","year":"2022","journal-title":"Pediatrics"},{"issue":"3","key":"2023111014132418300_B24","doi-asserted-by":"crossref","first-page":"e20174081","DOI":"10.1542\/peds.2017-4081","article-title":"Guidelines for Adolescent Depression in Primary Care (GLAD-PC): Part I. practice preparation, identification, assessment, and initial management","volume":"141","author":"Zuckerbrot","year":"2018","journal-title":"Pediatrics"},{"issue":"3","key":"2023111014132418300_B25","doi-asserted-by":"crossref","first-page":"e20174082","DOI":"10.1542\/peds.2017-4082","article-title":"Guidelines for Adolescent Depression in Primary Care (GLAD-PC): Part II. treatment and ongoing management","volume":"141","author":"Cheung","year":"2018","journal-title":"Pediatrics"},{"issue":"10","key":"2023111014132418300_B26","doi-asserted-by":"crossref","first-page":"1107","DOI":"10.1016\/j.jaac.2020.05.005","article-title":"Clinical practice guideline for the assessment and treatment of children and adolescents with anxiety disorders","volume":"59","author":"Walter","year":"2020","journal-title":"J Am Acad Child Adolesc Psychiatry"},{"issue":"3","key":"2023111014132418300_B27","first-page":"CD005170","article-title":"Pharmacotherapy for anxiety disorders in children and adolescents","author":"Ipser","year":"2009","journal-title":"Cochrane Database Syst Rev"},{"key":"2023111014132418300_B28","doi-asserted-by":"crossref","DOI":"10.1542\/9781610022002","volume-title":"Pediatric Psychopharmacology for Primary Care","author":"Riddle","year":"2018","edition":"2nd ed"},{"issue":"10","key":"2023111014132418300_B29","doi-asserted-by":"crossref","first-page":"1011","DOI":"10.1001\/jamapsychiatry.2017.2432","article-title":"Efficacy and safety of selective serotonin reuptake inhibitors, serotonin-norepinephrine reuptake inhibitors, and placebo for common psychiatric disorders among children and adolescents: a systematic review and meta-analysis","volume":"74","author":"Locher","year":"2017","journal-title":"JAMA Psychiatry"},{"issue":"0","key":"2023111014132418300_B30","article-title":"Clinical practice guideline for the assessment and treatment of children and adolescents with major and persistent depressive disorders","volume":"0","author":"Walter","year":"2022","journal-title":"J Am Acad Child Adolesc Psychiatry"},{"issue":"1","key":"2023111014132418300_B31","doi-asserted-by":"crossref","first-page":"41","DOI":"10.1001\/jamapsychiatry.2018.3070","article-title":"Different types and acceptability of psychotherapies for acute anxiety disorders in children and adolescents: a network meta-analysis","volume":"76","author":"Zhou","year":"2019","journal-title":"JAMA Psychiatry"},{"issue":"1","key":"2023111014132418300_B32","doi-asserted-by":"crossref","first-page":"102","DOI":"10.1007\/s10567-019-00303-2","article-title":"A meta-analysis to guide the enhancement of CBT for childhood anxiety: exposure over anxiety management","volume":"23","author":"Whiteside","year":"2020","journal-title":"Clin Child Fam Psychol Rev"},{"issue":"1","key":"2023111014132418300_B33","doi-asserted-by":"crossref","first-page":"26","DOI":"10.1097\/00004583-199801000-00013","article-title":"Cognitive-behavioral therapy of depression and depressive symptoms during adolescence: a review and meta- analysis","volume":"37","author":"Reinecke","year":"1998","journal-title":"J Am Acad Child Adolesc Psychiatry"},{"issue":"3","key":"2023111014132418300_B34","doi-asserted-by":"crossref","first-page":"272","DOI":"10.1097\/00004583-199903000-00014","article-title":"Cognitive-behavioral treatment of adolescent depression: efficacy of acute group treatment and booster sessions","volume":"38","author":"Clarke","year":"1999","journal-title":"J Am Acad Child Adolesc Psychiatry"},{"issue":"8","key":"2023111014132418300_B35","doi-asserted-by":"crossref","first-page":"930","DOI":"10.1097\/01.chi.0000127589.57468.bf","article-title":"Cognitive-behavioral psychotherapy for anxiety and depressive disorders in children and adolescents: an evidence-based medicine review","volume":"43","author":"Compton","year":"2004","journal-title":"J Am Acad Child Adolesc Psychiatry"},{"issue":"4","key":"2023111014132418300_B36","doi-asserted-by":"crossref","first-page":"463","DOI":"10.1111\/j.1440-1819.2009.01991.x","article-title":"Randomized study of school-based intensive interpersonal psychotherapy for depressed adolescents with suicidal risk and parasuicide behaviors","volume":"63","author":"Tang","year":"2009","journal-title":"Psychiatry Clin Neurosci"},{"issue":"6","key":"2023111014132418300_B37","doi-asserted-by":"crossref","first-page":"577","DOI":"10.1001\/archpsyc.61.6.577","article-title":"A randomized effectiveness trial of interpersonal psychotherapy for depressed adolescents","volume":"61","author":"Mufson","year":"2004","journal-title":"Arch Gen Psychiatry"},{"issue":"26","key":"2023111014132418300_B38","doi-asserted-by":"crossref","first-page":"2753","DOI":"10.1056\/NEJMoa0804633","article-title":"Cognitive behavioral therapy, sertraline, or a combination in childhood anxiety","volume":"359","author":"Walkup","year":"2008","journal-title":"N Engl J Med"},{"issue":"11","key":"2023111014132418300_B39","doi-asserted-by":"crossref","first-page":"1049","DOI":"10.1001\/jamapediatrics.2017.3036","article-title":"Comparative effectiveness and safety of cognitive behavioral therapy and pharmacotherapy for childhood anxiety disorders: a systematic review and meta-analysis","volume":"171","author":"Wang","year":"2017","journal-title":"JAMA Pediatr"},{"issue":"2","key":"2023111014132418300_B40","doi-asserted-by":"crossref","first-page":"377","DOI":"10.1016\/j.jbi.2008.08.010","article-title":"Research electronic data capture (REDCap)--a metadata-driven methodology and workflow process for providing translational research informatics support","volume":"42","author":"Harris","year":"2009","journal-title":"J Biomed Inform"},{"key":"2023111014132418300_B41","doi-asserted-by":"crossref","first-page":"103208","DOI":"10.1016\/j.jbi.2019.103208","article-title":"The REDCap consortium: Building an international community of software platform partners","volume":"95","author":"Harris","year":"2019","journal-title":"J Biomed Inform"},{"issue":"4","key":"2023111014132418300_B42","doi-asserted-by":"crossref","first-page":"558","DOI":"10.3122\/jabfm.2018.04.170222","article-title":"Screenings during well-child visits in primary care: a quality improvement study","volume":"31","author":"Wakai","year":"2018","journal-title":"J Am Board Fam Med"},{"issue":"3","key":"2023111014132418300_B43","doi-asserted-by":"crossref","first-page":"340","DOI":"10.1007\/s11414-017-9580-9","article-title":"When behavioral health concerns present in pediatric primary care: factors influencing provider decision-making","volume":"45","author":"Connors","year":"2018","journal-title":"J Behav Health Serv Res"},{"key":"2023111014132418300_B44","article-title":"Released 2020","volume-title":"IBM SPSS Statistics for Windows, Version 27.0","author":"IBM Corp"},{"issue":"4","key":"2023111014132418300_B45","doi-asserted-by":"crossref","first-page":"545","DOI":"10.1097\/00004583-199704000-00018","article-title":"The Screen for Child Anxiety Related Emotional Disorders (SCARED): scale construction and psychometric characteristics","volume":"36","author":"Birmaher","year":"1997","journal-title":"J Am Acad Child Adolesc Psychiatry"},{"issue":"9","key":"2023111014132418300_B46","doi-asserted-by":"crossref","first-page":"606","DOI":"10.1046\/j.1525-1497.2001.016009606.x","article-title":"The PHQ-9: validity of a brief depression severity measure","volume":"16","author":"Kroenke","year":"2001","journal-title":"J Gen Intern Med"},{"issue":"10","key":"2023111014132418300_B47","doi-asserted-by":"crossref","first-page":"1092","DOI":"10.1001\/archinte.166.10.1092","article-title":"A brief measure for assessing generalized anxiety disorder: the GAD-7","volume":"166","author":"Spitzer","year":"2006","journal-title":"Arch Intern Med"},{"issue":"5","key":"2023111014132418300_B48","doi-asserted-by":"crossref","first-page":"545","DOI":"10.1016\/S0005-7967(98)00034-5","article-title":"A measure of anxiety symptoms among children","volume":"36","author":"Spence","year":"1998","journal-title":"Behav Res Ther"},{"issue":"7","key":"2023111014132418300_B49","doi-asserted-by":"crossref","first-page":"816","DOI":"10.1177\/0009922819834280","article-title":"Ready for the challenge of depression care in the medical home","volume":"58","author":"Garbutt","year":"2019","journal-title":"Clin Pediatr (Phila)"},{"issue":"1","key":"2023111014132418300_B50","doi-asserted-by":"crossref","first-page":"28","DOI":"10.1097\/DBP.0000000000000008","article-title":"Primary care providers\u2019 initial treatment decisions and antidepressant prescribing for adolescent depression","volume":"35","author":"Radovic","year":"2014","journal-title":"J Dev Behav Pediatr"}],"container-title":["Pediatrics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/publications.aap.org\/pediatrics\/article-pdf\/doi\/10.1542\/peds.2022-058846\/1565563\/peds_2022058846.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/publications.aap.org\/pediatrics\/article-pdf\/doi\/10.1542\/peds.2022-058846\/1565563\/peds_2022058846.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,11,10]],"date-time":"2023-11-10T14:13:58Z","timestamp":1699625638000},"score":1,"resource":{"primary":{"URL":"https:\/\/publications.aap.org\/pediatrics\/article\/151\/5\/e2022058846\/191068\/Anxiety-and-Depression-Treatment-in-Primary-Care"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,4,17]]},"references-count":50,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2023,4,17]]},"published-print":{"date-parts":[[2023,5,1]]}},"URL":"https:\/\/doi.org\/10.1542\/peds.2022-058846","relation":{},"ISSN":["0031-4005","1098-4275"],"issn-type":[{"value":"0031-4005","type":"print"},{"value":"1098-4275","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,4,17]]},"article-number":"e2022058846"}}