Youth Mental Health

Two of the most common mental health disorders among youth are anxiety and depression. The Youth Mental Health: Anxiety and Depression Tool was developed to help guide conversations about anxiety and depression with youth patients over a series of visits.

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Question #2: Which is a first line pharmacotherapy for treatment of depression?

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Tool

Youth Mental Health Tool
the tool

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Approximately 20 per cent of Ontario youth have a mental health disorder causing significant distress and impairing their functioning at home, at school, with peers or in the community. The most common are anxiety, and behavioural and depressive disorders. The Youth Mental Health: Anxiety and Depression Tool is designed to help family physicians and primary care nurse practitioners detect and manage anxiety and depression among youth patients aged 12 – 24.

Intended to be used over a series of visits, the tool is divided into the following four key sections:

  1. Screening and assessment
  2. Management
  3. Follow-up and monitoring
  4. Supporting your patient

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Project Overview

76 per cent of Ontario primary care providers we surveyed indicated an interest in receiving a clinical tool on youth mental health. The Youth Mental Health: Anxiety and Depression Tool was developed help providers screen and manage patients between the ages of 12 and 24 who may be suffering from anxiety and depression.

Development Process

The Youth Mental Health: Anxiety and Depression Tool was developed using the CEP’s integrated knowledge translation approach. This approach ensures that providers are engaged throughout the development processes through the application of user-centered design methodology. Clinical leadership of the resource was provided by Dr. Muna Chowdhury. A group of clinical and system experts were also engaged to provide feedback on the tool.

The Youth Mental Health: Anxiety and Depression Tool is one of several resources developed as part of the 2014 to 2017 Knowledge Translation in Primary Care Initiative. This multi-year initiative was a collaboration between the Centre for Effective Practice (CEP), Ontario College of Family Physicians (OCFP), and Nurse Practitioners’ Association of Ontario (NPAO). Funded by the Ministry of Health and Long-Term Care, this initiative supported primary care providers with the development of a series of clinical tools and health information resources. Learn more about the Knowledge Translation in Primary Care Initiative.

As part of this initiative, CEP conducted a Primary Care Needs Assessment to determine topics of interest to primary care providers. In this survey, providers identified the need for more effective resources to help identify and manage risks associated with mental health conditions.

Meet the Team

 The need for a more effective approach to youth mental health was identified by Ontario primary care providers as part of the Knowledge Translation in Primary Care Initiative. The Centre for Effective Practice enlisted the collaboration of clinical leads and a clinical working group to create the tool.

Clinical Lead

NameMuna Chowdhury, MD, FCFP

Muna Chowdhury is a family physician at Queen West Community Health Centre. She has extensive experience in all aspects of adolescent health and expertise in providing primary and mental health care to high risk and homeless youth. As a University of Toronto faculty member, she enjoys teaching and mentoring learners at all levels, from medical students to fellows and other physician preceptors. Dr. Chowdhury is also involved in leadership, advocacy and program development related to adolescent health, and is well known among the youth-serving agencies in Toronto.

Expert Opinion

The CEP sought expert input to inform the Youth Mental Health: Anxiety and Depression Tool. We are grateful to all the individuals for their time and expertise.

  • Chris Langlois
  • Dr. Amy Cheung
  • Gail Czukar
  • Kimberly Moran
  • Valery Navarete
  • Catherine Ford
  • Sarah Labert
  • Michelle Hurtubise

Supporting Material

Here are some additional resources and sources of information. These supporting materials are hosted by external organizations and we cannot guarantee the accuracy and accessibility of their links. CEP will make every effort to keep these links up to date.

Supporting Material

  1. PHQ Screeners. PHQ and GAD-7 screeners (available in several different languages).
    http://www.phqscreeners.com/select-screener/41
  2. University of Pittsburgh. Screen for Child Anxiety Related Emotional Disor-ders (SCARED; for youth up to age 18).
    http://www.pediatricbipolar.pitt.edu/content.asp?id=2333
  3. Cary Behavioral Health PC. Generalized anxiety disorder (GAD) screener (age 18+).
    http://carybehavioralhealth.com/wp-content/uploads/2011/06/ General-ized-Anxiety-Scale.pdf
  4. National Institutes of Mental Health (NIMH). Ask Suicide-Screening Questions [ASQ] screener (4 questions).
    http://www.pcmch.on.ca/wp-content/up-loads/2015/09/1.4-Appendix_3-ASQ-Information_sheet_and_ instrument.pdf
  5. American Academy of Pediatrics. Substance Use Screening, Brief Interven-tion, and Referral to Treatment (SBIRT) for Pediatricians (screening and talking points on substance use).
    http://pediatrics.aappublications.org/content/pediatrics/early/2011/10/26/peds.2011-1754.full.pdf
  6. American Medical Association. Creating an LGTBQ-friendly medical practice.
    https://www.ama-assn.org/delivering-care/creating-lgbtq-friendly-practice
  7. Centre for Effective Practice. Management of Chronic Insomnia.
    https://thewellhealth.ca/insomnia
  8. Kelty Mental Health. Antidepressant Monitoring Form for Children and Ado-lescents. The Antidepressant Monitoring Form:
    http://keltymentalhealth.ca/sites/default/andales/antidepressant_monitoring_ form_-_may_2013.pdf
  9. Centre for Effective Practice. Poverty: A Clinical Tool for Primary Care Provid-ers. https://thewellhealth.ca/poverty
    Dieticians of Canada. Find a Dietician.
    https://www.dietitians.ca/Your-Health/Find-A-Dietitian/Find-a-Dietitian.aspx
  10. Centre for Effective Practice. Keeping Your Patients Safe.
    https://thewell-health.ca/mentalhealthrisk
  11. Teen Mental Health. Clinical Global Impression (CGI) scale (brief monitoring tool that works for both depression and anxiety)
    http://teenmentalhealth.org/product/clinical-global-impression-cgi/
  12. Brandeis University. Beck Anxiety Inventory.
    http://www.brandeis.edu/roybal/docs/BAI_website_PDF.pdf
  13. Yale-Brown Obsessive-Compulsive Scale (Y-BOCS; age 18+).
    http://health-net.umassmed.edu/mhealth/YBOCRatingScale.pdf
  14. American Psychiatric Association. Online assessment measures: Severity Measure for Panic, Adult (Age 18+).
    https://www.psychiatry.org/psychiatrists/practice/dsm/educational-resources/assessment-measures
  15. The Ontario College of Family Physician Collaborative Mental Health Network (CMHN):
    http://ocfp.on.ca/cpd/collaborative-networks/cmhn
  16. Ontario Telemedicine Network (OTN). OTNHub (eReferral, eVisit, eCare).
    https://otn.ca/health%20care-professionals/
  17. Moving on Mental Health. Service Area and Lead Agencies (for access to mental health services in your area).
    http://www.children.gov.on.ca/htdocs/english/documents/specialneeds/mentalhealth/momh.pdf
  18. Project ECHO: Mental Health and Addiction. (Knowledge sharing and men-torship network for practitioners).
    https://www.echoontario.ca/Echo-Clinic/Mental-Health-and-Addictions.aspx
  19. CAMH. Antidepressant Medication (patient handout).
    http://www.camh.ca/en/hospital/health_information/a_z_mental_health_and_addiction_informa-tion/drug-use-addiction/Pages/addiction.aspx
  20. Children’s Mental Health Ontario. Find a CMHO centre in your community.
    http://cmho.org/find-help/find-a-centre
  21. Resources for youth and families

  22. Canadian Society for Exercise Physiology. Canadian Physical Activity Guidelines.
    http://www.csep.ca/en/guidelines/canadian-24-hour-move-ment-guidelines
  23. Ontario Association of Food Banks. Find a Food Bank.
    https://oafb.ca/need-help/find-a-food-bank/
  24. Daily Bread Food Bank. Get Support.
    http://www.dailybread.ca/get-support/
  25. Sustain Ontario. Community Garden Network.
    https://sustainontario.com/initiatives/community-garden-network
  26. 211 Ontario. 24/7 free service that connects to community and social ser-vices in your area. Dial 211 or visit
    https://211ontario.ca/
  27. Self-Help Resource Centre. CBT Therapists – OHIP Covered.
    http://www.selfhelp.on.ca/2015/08/cbt-therapists-ohip-covered/
  28. Australian National University. MoodGym (free online CBT).
    https://moodgym.anu.edu.au/welcome
  29. Mindshift App (for Anxiety):
    https://www.anxietybc.com/resources/mind-shift-app
  30. MoodTools (for depression):
    http://www.moodtools.org/
  31. MoodKit – Mood Improvement Tools:
    https://itunes.apple.com/ca/app/mood-kit-mood-improvement-tools/id427064987?mt=8
  32. Anxiety and Depression Association of America (ADAA). Mental Health Apps (reviewed by the ADAA).
    https://www.adaa.org/finding-help/mobile-apps
  33. e-Couch:
    https://ecouch.anu.edu.au/welcome
  34. Distress Centres and Crisis Ontario. Ontario Distress Centres:
    http://www.dcontario.org/centres.html
  35. Wellness Recovery Action Plan (WRAP):
    http://mentalhealthrecovery.com/wrap-is/
  36. Children’s Hospital of Eastern Ontario. Safety plan for your having thoughts of suicide:
    http://mentalhealthrecovery.com/wrap-is/
  37. thehealthline.ca:
    http://www.thehealthline.ca/
  38. Ontario Mental Health Helpline:
    http://www.mentalhealthhelpline.ca/
  39. CAMH. Health information:
    http://www.camh.ca/en/hospital/health_infor-mation/Pages/default.aspx
  40. Kids Help Phone:
    https://kidshelpphone.ca/
  41. Stop a Bully:
    http://www.stopabully.ca/
  42. [email protected]:
    https://www.safeatschool.ca/resources
  43. Canadian Safe School Network:
    https://canadiansafeschools.com
  44. Ministry of Education. Caring and Safe Schools in Ontario:
    http://www.edu.gov.on.ca/eng/general/elemsec/speced/Caring_Safe_School.pdf
  45. The Access Point:
    http://theaccesspoint.ca/
  46. eMentalHealth.ca:
    http://www.ementalhealth.ca/Ontario/
  47. ConnexOntario. Health Services Information:
    http://connexontario.ca/
  48. Canadian Mental Health Association (CMHA). Youth.
    http://www.cmha.ca/mental-health/your-mental-health/youth/
  49. Ontario Peer Development Initiative:
    http://www.opdi.org/members.php
  50. Canadian Paediatric Society. How to talk with your teen:
    http://www.caring-forkids.cps.ca/handouts/talk_with_your_teen
  51. Anxiety BC. Youth.
    http://youth.anxietybc.com/
  52. BC Ministry of Health. Anxiety in Children and Youth: A Guide for Parents.
    http://www2.gov.bc.ca/assets/gov/health/practitioner-pro/bc-guidelines/depressyouth_guide_parents_anxiety.pdf
  53. Dealing with Depression: Antidepressant Skills for Teens.
    https://www.sfu.ca/carmha/publications/dwd.html
  54. Centre for Addiction and Mental Health (CAMH). CBT for young adults online (2-year study; receive free CBT online).
    http://www.camh.ca/en/hospital/about_camh/newsroom/CAMH_in_the_headlines/stories/Pages/Researchers-take-cognitive-behavioural-therapy-for-young-adults-online.aspx
  55. Parents’ Lifelines of Eastern Ontario. Coping when your child has mental health challenges.
    http://www.pleo.on.ca/wp-content/uploads/2013/06/PLEO-Coping-EN-Web-Version.pdf
  56. Not Myself Today. Fighting mental health stigma at work.
    http://www.notmy-selftoday.ca/?gclid=CJWDnePZhNICFQ2TaQod7eQPpw
  57. Partners for Mental Health. Right By You.
    http://rightbyyou.ca/en?gclid=CP-fU44nehNICFYQDaQodYdUMmQ
  58. CMHA. LGBTQ Identi ed People and Mental Health.
    https://ontario.cmha.ca/documents/lesbian-gay-bisexual-trans-queer-identified-people-and-men-tal-health/
  59. Rainbow Health Ontario. LGBTQ Mental Health Factsheet.
    http://www.rain-bowhealthontario.ca/resources/lgbt-mental-health-fact-sheet/
  60. Government of Canada Department of Justice. Get help with family violence.
    http://www.justice.gc.ca/eng/cj-jp/fv-vf/help-aide.html
  61. Ontario Ministry of the Status of Women. Getting help. 1-866-863-0511.
    http://www.women.gov.on.ca/owd/english/ending-violence/help.shtml
  62. Teen Mental Health. Transitions.
    http://teenmentalhealth.org/product/tran-sitions/

References

  1. Canadian Mental Health Association – British Columbia Division. Mental illnesses in children and youth. Available from: https://www.cmha.bc.ca/documents/mental-illnesses-in-children-and-youth-2/ [Accessed 15 May 2017].
  2. U.S. Preventive Services Task Force. Final recommendation statement – depression in children and adolescents: screening. Available from: https://www.uspreventiveservicestaskforce.org/Page/Document/RecommendationStatementFinal/depression-in-children-and-adolescents-screening1 [Accessed 15 May 2017].
  3. Siu AL, U.S. Preventive Services Task Force. Screening for depression in adults: U.S. Preventive Services Task Force recommendation Statement. JAMA. 2016;315(4):380-387.
  4. Katzman MA, Bleau P, Blier P, Chokka P, Kjernisted K, Van Ameringen M, et al. Canadian clinical practice guidelines for the management of anxiety, posttraumatic stress and obsessive-compulsive disorders. BMC Psychiatry. 2014;14(Suppl 1):S1.
  5. Connolly SD, Bernstein GA, Work Group on Quality Issues. Practice parameter for the assessment and treatment of children and adolescents with anxiety disorders. Am. Acad. Child Adolesc. Psychiatry. 2007;46(2):267-283.
  6. Richardson LP, McCauley E, Grossman DC, McCarty CA, Richards J, Russo JE, et al. Evaluation of the Patient Health Questionnaire-9 Item for detecting major depression among adolescents. Pediatrics. 2010;126(6):1117-1123.
  7. British Columbia Guidelines and Protocols Advisory Committee. Anxiety and depression in children and youth – diagnosis and treatment. Available from: http://www2.gov.bc.ca/gov/content/health/practitioner-professional-resources/bc-guidelines/anxiety-and-depression-in-youth#considerations [Accessed 15 May 2017].
  8. Institute for Clinical Systems Improvement. Depression, adult in primary care. Available from: https://www.icsi.org/guidelines__more/catalog_guidelines_and_more/catalog_guidelines/catalog_behavioral_health_guidelines/depression/ [Accessed 15 May 2017].
  9. McDermott B, Baigent M, Chanen A, Fraser L, Graetz B, Hayman N, et al. Clinical practice guidelines: Depression in adolescents and young adults. Available from: https://www.beyondblue.org.au/health-professionals/clinical-practice-guidelines [Accessed 15 May 2017].
  10. Clark MS, Jansen KL, Cloy JA. Treatment of childhood and adolescent depression. Am Fam Physician. 2012;86(5):442-448.
  11. Brezing C, Derevensky JL, Potenza MN. Non-substance-addictive behaviors in youth: Pathological gambling and problematic internet use. Child Adolesc Psychiatr Clin N Am. 2010;19(3):625-641.
  12. Canadian Paediatric Society. Gambling in children and adolescents. Available from: http://www.cps.ca/documents/position/gambling-children-adolescents [Accessed 15 May 2017].
  13. Kiraly O, Griffths MD, Urban R, Farkas J, Kokonyei G, elekes Z, et al. Problematic internet use and problematic online gaming are not the same: Findings from a large nationally representative adolescent sample. Cyberpsychol Behav Soc Netw. 2014;17(12):749-54.
  14. American Academy of Pediatrics Committee of Substance Abuse. Policy statement: Substance use screening, brief intervention, and referral to treatment for pediatricians. Pediatrics. 2011;128(5):e1330-e1340.
  15. Lamb J, Pepler DJ, Craig W. Approach to bullying and victimization. Can Fam Phys. 2009;55(4):356-60.
  16. MacQueen GM, Frey BN, Ismail Z, Jaworska N, Steiner M, Lieshout RJ, et al. Canadian Network for Mood and Anxiety Treatments (CANMAT) 2016 clinical guidelines for the management of adults with major depressive disorder: Section 6: Special populations: youth, women, and the elderly. Can J Psychiatry. 2016;61(9):588-603.
  17. Centre for Effective Practice. Management of chronic insomnia. Available from: https://thewellhealth.ca/insomnia [Accessed 15 May 2017].
  18. Dietitians of Canada. Promoting mental health through healthy eating and nutritional care. Available from: https://www.dietitians.ca/Downloads/Public/Nutrition-and-Mental-Health-complete-2012.aspx [Accessed 15 May 2017].
  19. EatRight Ontario. What is a registered dietitian? Available from: https://www.eatrightontario.ca/en/Articles/Nutrition-Month/What-is-a-Registered-Dietitian.aspx [Accessed 15 May 2017].
  20. Centre for Addiction and Mental Health. Antidepressant medication. Available from: http://www.camh.ca/en/hospital/health_information/a_z_mental_health_and_addiction_information/antidepressant_medication/Pages/antidepressant_medication.aspx [Accessed 15 May 2017].
  21. Ipser JC, Stein DJ, Hawkridge S, Hoppe L. Pharmacotherapy for anxiety disorders in children and adolescents. Cochrane Database Syst Rev. 2009;8;(3):CD005170.
  22. Kodish I, Rockhill C, Varley C. Pharmacotherapy for anxiety disorders in children and adolescents. Dialogues Clin Neurosci. 2011;13(4):439-452.
  23. Overbeck G, Davidsen AS, Kousgaard MB. Enablers and barriers to implementing collaborative care for anxiety and depression: A systematic qualitative review. Implement Sci. 2016;11:165.
  24. Canadian Mental Health Association. Case management services. Available from: http://toronto.cmha.ca/programs_services/case-management/#.WNz4QPE7Uck [Accessed 15 May 2017].
  25. Government of Ontario. Home and community care. Available from: https://www.ontario.ca/page/homecare-seniors [Accessed 15 May 2017].
  26. Empowering Parents. How to discipline kids: The key to being a consistent parent. Available from: https://www.empoweringparents.com/article/how-to-discipline-kids-the-key-to-being-a-consistent-parent/ [Accessed 15 May 2017].
  27. Canadian Paediatric Society. Supporting the mental health of children and youth of separating parents. Available from: http://www.cps.ca/documents/position/mental-health-children-and-youth-of-separating-parents [Accessed 15 May 2017].
  28. HealthyDebate. Lost in transition: The gap between child and adult mental health services. Available from: http://healthydebate.ca/opinions/mental-health-transitions [Accessed 15 May 2017].
  29. Canadian Medical Protective Association. Can a child provide consent? Available from: https://www.cmpa-acpm.ca/en/advice-publications/browse-articles/2014/can-a-child-provide-consent [Accessed 15 May 2017].
  30. Parents’ Lifelines of Eastern Ontario. Coping when your child has mental health challenges. Available from: http://www.pleo.on.ca/wp-content/uploads/2013/06/PLEO-Coping-EN-Web-Version.pdf [Accessed 15 May 2017].
  31. Escitalopram [product monograph]. Montreal, QC: Lundbeck Canada Inc., [updated June 9, 2016, cited 30 May 2017]. Available from: http://www.lundbeck.com/
  32. Buck ML. Escitalopram for treatment of depression in adolescents. Pediatr Pharm. 2009;15:9.
  33. Centers for Disease Control and Prevention. Sleep and sleep disorders. Available from: https://www.cdc.gov/sleep/about_sleep/how_much_sleep.html [accessed 15 May 2017].

Copyright & Disclaimer

CEP fully supports the use of the Youth Mental Health: Anxiety and Depression Tool by providers, educators, decision-makers and others. Please read the following information prior to use of the Tool to ensure appropriate permission is sought and appropriate citation is used.

Creative Commons License

Creative Commonsthe Youth Mental Health: Anxiety and Depression Tool is a product of the Centre for Effective Practice.  Permission to use, copy and distribute this material for all non-commercial and research purposes is granted, provided that all copies, modifications, and distributions contain full reproductions of this Creative Commons License and the following Disclaimer along with appropriate citation.  Use of the the Youth Mental Health: Anxiety and Depression Tool for commercial purposes or any modifications of the tool are subject to charge and use must be negotiated with Centre for Effective Practice (Email: [email protected])

For statistical and bibliographic purposes, please notify the Centre for Effective Practice ([email protected]) of any use or reprinting of the tool.

Please use this citation when referencing the tool: Reprinted with Permission from Centre for Effective Practice (June 2017). Youth Mental Health: Anxiety and Depression Tool. Toronto: Centre for Effective Practice.

Disclaimer

The Youth Mental Health: Anxiety and Depression Tool (the “Tool”) contains links to websites and other external resources (“Third Party Resources”) that are operated by and/or created by third party organizations.  These third party organizations are solely responsible for the information contained in, and the operation of (as applicable), their respective Their Party Resource(s).

This Tool was developed for licensed health care professionals in Ontario as a guide only and does not constitute medical or other professional advice.  Primary care providers and other health care professionals are required to exercise their own clinical judgment in using this Tool.

Neither the Centre for Effective Practice (“CEP”), Ontario College of Family Physicians, Nurse Practitioners’ Association of Ontario, Government of Ontario, the contributors to this Tool, nor any of their respective agents, appointees, directors, officers, employees, contractors, members or volunteers: (i) are providing medical, diagnostic or treatment services through this Tool; (ii) to the extent permitted by applicable law, accept any responsibility for the use or misuse of this Tool by any individual including, but not limited to, primary care providers, or entity, including for any loss, damage or injury (including death) arising from or in connection with the use of this Tool, in whole or in part; or (iii) give or make any representation, warranty or endorsement of any of the Third Party Resources, that are owned or operated by third parties, including any information or advice contained therein.