Élaborer un guide pratique de prise en charge de la dépression de l’enfant et de l’adolescent destiné aux médecins généralistes, adapté à leurs conditions d’exercice, implémentable sur un site internet d’aide à la prise en charge des principales pathologies mentales rencontrées en soins premiers.

Une méta revue systématique a été réalisée selon les recommandations PRISMA. Les bases de données Pubmed, Cochrane et Web of Science ont été explorées. Chaque étape a été réalisée indépendamment par deux chercheurs. Étaient inclus les articles, publiés entre 2002 et 2015, traitant de la prise en charge en soins premiers de patients de 6 à 18 ans ayant un diagnostic d’épisode dépressif caractérisé. Les grilles AGREE II, PRISMA et R-AMSTAR ont été utilisées pour évaluer la qualité méthodologique des études. Trente-huit articles ont été inclus : 12 recommandations, cinq revues systématiques et 21 méta analyses.

Les données ont été synthétisées sous la forme d’un guide pratique destiné aux médecins généralistes. Pour un épisode dépressif caractérisé léger, une thérapie de soutien et une surveillance sont préconisées pendant quatre à six semaines. Pour un épisode dépressif caractérisé modéré à sévère, le jeune patient doit être orienté vers un spécialiste. Le traitement indiqué est une psychothérapie qui peut être combinée avec de la fluoxétine, avec une réévaluation entre 4 et 8 semaines.

Un guide élaboré à partir des données les mieux évaluées de la littérature a été créé pour aider le médecin généraliste dans la prise en charge d’un épisode dépressif caractérisé de l’enfant et de l’adolescent.

To develop a practical guide for the management of child and adolescent depression for general practitioners (GPs), suited to their practice frame, that can be implemented on a website aimed to help GPs to manage the main mental disorders encountered in primary care.

A systematic meta-review was performed as recommended by the PRISMA statement. Each step, articles’ selection, inclusion, methodological assessment and data extraction for the narrative synthesis was independently performed by two researchers. A study protocol was registered on PROSPERO (number CRD42016042710). The databases Pubmed, Cochrane and Web of Science were explored. Each step was performed independently by two researchers following PRISMA. Meta-analyses and systematic reviews (including guidelines based on a systematic review), published between 2002 and 2015, in English or French, dealing with the therapeutic management, in primary care, of patients aged 6 to 18 years old with a major depressive disorder (MDD) were included. Grey literature was explored searching the websites of national and international health agencies, learned societies, and article references. The methodological and report qualities were assessed using the AGREE II, PRISMA checklist and R-AMSTAR grid. A narrative synthesis was performed to produce the practical guide, prioritizing data from the best evaluated articles. An expert group of GPs’ and one child psychiatrist validated the guide in its final form.

Thirty-eight studies were included: 12 recommendations, 5 systematic reviews and 21 meta-analyses. The best evaluated guideline had an AGREE-II assessment of 81%, and the best evaluated meta-analysis had an assessment of 86% for R-AMSTAR and 96% for PRISMA. The average scores of the R-AMSTAR and PRISMA assessments were 65% and 72% respectively. The average score of the AGREE II grid assessment was 57%. The data were synthesized into a practical guide for the GPs’ practice, corresponding to the different consultation times. MDD diagnosis should be done on the DSM or ICD basis. The Childrens’ Depression Rating Scale-revised or the Revised Beck Depression Inventory are useful in primary care for MDD appraisal in children and adolescents. For mild MDD a supportive psychotherapy and surveillance for 4 to 6 weeks is preconized in primary care. In the absence of improvement, a specific and structured psychotherapy is recommended, and the patient should be addressed to a child psychiatrist. For moderate to severe MDD, the young patient should be addressed to a specialist in child psychiatry. A psychotherapy, which can be associated with fluoxetine, especially in adolescents, is indicated with a revaluation of the pharmacological treatment between 4 to 8 weeks. A weekly follow-up by the GP is recommended during the first month, especially after the initiation of an antidepressant to assess the suicidal risk. Beyond the first month, a consultation should be scheduled every two weeks.

A clinical guide was created from the best evidence-based data to help GPs in the management of child and adolescent MDD. A French-language website, aimed to assist GPs in mental disease management and available during their consultation, will be created based on the compilation of this meta-review with other similar meta-reviews.