A new Web site, www.depressedteens.com, was launched this fall, providing information and access to resources about clinical depression and bipolar disorder. The site was developed by the Rodwell Dart Memorial Foundation in cooperation with the Depression and Related Affective Disorders Association (DRADA) and the Johns Hopkins School of Medicine. The site seeks to help educators who work with teens recognize depression. A 26-minute VHS video, "Day for Night: Recognizing Teenage Depression" is a featured resource available through the site with an accompanying teachers' guide. Clips from the video can be viewed at the Web site. [PR Newswire]

Carol A. Ford, M. D., of the University of North Carolina at Chapel Hill, and colleagues examined adolescents' understanding of conditional confidentiality in order to improve physicians' ability to discuss confidentiality with adolescents. Confidentiality is important in ensuring adolescents' willingness to discuss sensitive health concerns and seek treatment, but the guidelines for physicians are complex. Physicians may communicate varying messages regarding confidentiality when they consult with adolescent patients.

Out of 171 students in three 9th and three 12th grade classes in a public school, 77 (60%) were eligible to participate based on completed consent forms, positive written parental consent and student assent. Twenty-seven 9th grade and 26 12th grade students were randomly selected to participate in a 40-minute semistructured private interview. In the interviews, students were given 37 cards labeled with topics concerning sexuality, tobacco/alcohol use and mental health and asked to sort them into three piles representing what they thought physicians would do if such information was discussed during a physician visit. The choices were:

• Most doctors would tell parents, regardless of teen's wishes.
• Most doctors would not tell parents.
• Not sure what most doctors would do.

Next, the students were asked to resort the cards after hearing the following conditional assurance of confidentiality, modeled after one published by the American Medical Association:

"I want you to understand that when we talk about things that have to do with sex and drugs and your feelings, that is confidential. This means that what we talk about is just between you and me and that other people including your parents will not find out about it unless you want them to know. One exception to this is if I am concerned someone has abused or hurt you. Another exception to this is if I am concerned you are planning to commit suicide. In these situations I would have to talk to other adults, but I would talk to you first so we could figure out the best way to handle it."

Before hearing the confidentiality statement, approximately 90 percent of the students were aware that most doctors would tell parents about sexual abuse, suicide or homicide, regardless of teens wishes and 81 percent reported that most doctors would tell parents if they were concerned about physical abuse.

Conversely, relatively few students knew of the protections to confidentiality before hearing the statement. The researchers report that before hearing the statement, only 40 to 51 percent of the students reported that doctors would provide confidential care for discussions about having sex or sexually transmitted disease (STD) concerns, receiving birth control injections and being tested for STDs or HIV. Only six percent of students believed that doctors would keep an STD diagnosis confidential. After hearing the confidentiality statement, only a minority of students (28%) believed that most doctors would keep an STD diagnosis confidential.

Results for substance use were similar. Before hearing the statement, 43 percent of students reported that most doctors would provide confidential care if teens reported daily tobacco use, 51 percent if teens tried marijuana a few times and 60 percent if teens reported monthly alcohol use. After hearing the confidentiality statement, the percentage of teens reporting that most doctors would provide confidential care in those situations increased to 60 percent, 70 percent and 72 percent.

The students made several suggestions for ways physicians could increase adolescents' understanding and trust of confidentiality, including:

• Emphasize the protections of confidentiality.
• Explain the limits of confidentiality in terms of caring rather than legal obligations.
• Be very specific about what can and what cannot be kept confidential.
• Do not use the word "except", as it seems contradictory.
• Use the phrase "I promise".
• Act trustworthy.
• Communicate how you will manage "gray" areas.
• Supplement physician discussions with information in other media.

The researchers conclude that teens know more about the limitations of confidentiality than the protections of confidentiality. "This suggests that physicians should emphasize the protections of confidentiality during conditional assurances, particularly for specific services that many adolescents need and for which privacy is well protected such as contraception, STD diagnosis and STD treatment".

Ford, CA, Thomsen SL, Compton B: Adolescents' interpretations of conditional confidentiality assurances. Journal of Adolescent Health 2001; 29: 156-159. For reprints, contact: Dr. Ford, Wing C Medical School, University of North Carolina, CB#7225, Chapel Hill, NC+C27599-7225; e-mail: caf@med.unc.edu