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Exploring the identification and treatment of adolescent anxiety in primary care: the perceptions of primary care providers'

Williams, Kelly (2019) Exploring the identification and treatment of adolescent anxiety in primary care: the perceptions of primary care providers'. Doctoral Dissertation, University of Pittsburgh. (Unpublished)

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Anxiety is the most prevalent adolescent behavioral health condition. Impairments caused by anxiety negatively impact educational performance, and social and emotional functioning. Moreover, future consequences of undetected and untreated anxiety include increased risk for other behavioral health conditions, obesity, and smoking. Despite the high prevalence of anxiety and the chronic nature of untreated anxiety, only about one third of youth with anxiety disorders receive treatment, constituting a public health problem.
No national guidelines exist for primary care providers regarding the identification and treatment of adolescent anxiety. Moreover, anxiety-specific research in pediatric primary care is limited. As such, this qualitative interview study sought to understand what factors, at the provider, organizational-, and policy-level, influence primary care providers decisions and capacity to identify and treat adolescent anxiety.
Of the 22 providers interviewed, nearly all perceived identification of adolescent anxiety as part of their professional role. Providers were divided on how anxiety should be identified. Half of providers believed a short, systematic screening tool would be beneficial for initial identification. Others perceived it was necessary to utilize anxiety screening tools only after the potential concern was identified. While a majority of providers had prescribed medications for adolescents with anxiety, not all providers viewed it as their role to prescribe and/or manage medication treatments. Several providers viewed their role as initiating treatment until the adolescent was able to see a specialist, while other providers commented on treatment roles as being strictly referral based. Barriers including lack of time, experience, training, and comfort, fear of medication side effects, and not having an embedded behavioral health provider were discussed as limiting factors on primary care providers’ capacity to treat anxiety.
Future research should focus on how both the identified factors influencing primary care providers’ capacity to treat anxiety and their treatment role perceptions impact decisions to routinely screen for anxiety. Efforts to standardize primary care providers’ capacity for anxiety treatment and identification may decrease treatment gaps; the development of evidence-based national guidelines and expectations may facilitate increased primary care providers’ confidence with implementing treatment plans and may support increased resources, training, and education from an organizational standpoint.


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Item Type: University of Pittsburgh ETD
Status: Unpublished
CreatorsEmailPitt UsernameORCID
Williams, Kellykrw41@pitt.edukrw41
ETD Committee:
TitleMemberEmail AddressPitt UsernameORCID
Committee ChairTrauth,
Committee MemberHawk,
Committee MemberBear,
Committee MemberRadovic,
Date: 28 June 2019
Date Type: Publication
Defense Date: 1 April 2019
Approval Date: 28 June 2019
Submission Date: 3 April 2019
Access Restriction: 2 year -- Restrict access to University of Pittsburgh for a period of 2 years.
Number of Pages: 182
Institution: University of Pittsburgh
Schools and Programs: School of Public Health > Behavioral and Community Health Sciences
Degree: PhD - Doctor of Philosophy
Thesis Type: Doctoral Dissertation
Refereed: Yes
Uncontrolled Keywords: adolescent; anxiety; primary care providers
Date Deposited: 28 Jun 2019 13:48
Last Modified: 01 May 2021 05:15


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